Healthcare Provider Details

I. General information

NPI: 1891390688
Provider Name (Legal Business Name): TREE BY THE SEA COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14989 S DIXIE HWY
MONROE MI
48161-3769
US

IV. Provider business mailing address

5068 N DIXIE HWY
NEWPORT MI
48166-9691
US

V. Phone/Fax

Practice location:
  • Phone: 734-265-0334
  • Fax: 734-241-0014
Mailing address:
  • Phone: 734-265-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ELISHA LIETO
Title or Position: OWNER
Credential: LMSW
Phone: 734-265-0334