Healthcare Provider Details

I. General information

NPI: 1568801454
Provider Name (Legal Business Name): ALISON LEA CISNEROS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 JOLLY RD STE 160
OKEMOS MI
48864-5977
US

IV. Provider business mailing address

2395 JOLLY RD STE 160
OKEMOS MI
48864-5977
US

V. Phone/Fax

Practice location:
  • Phone: 517-301-5011
  • Fax: 517-879-4889
Mailing address:
  • Phone: 517-301-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801094742
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: