Healthcare Provider Details

I. General information

NPI: 1073982427
Provider Name (Legal Business Name): FRANCES KERSTHOLT-SULLIVAN LBSW QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 N SKEEL AVE SUITE 6
OSCODA MI
48750-1535
US

IV. Provider business mailing address

5671 N SKEEL AVE SUITE 6
OSCODA MI
48750-1535
US

V. Phone/Fax

Practice location:
  • Phone: 989-747-3036
  • Fax:
Mailing address:
  • Phone: 989-747-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802064622
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: