Healthcare Provider Details

I. General information

NPI: 1396480109
Provider Name (Legal Business Name): SET APART COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 GOULDEN ST
PORT HURON MI
48060-6934
US

IV. Provider business mailing address

3110 GOULDEN ST
PORT HURON MI
48060-6934
US

V. Phone/Fax

Practice location:
  • Phone: 810-956-9483
  • Fax:
Mailing address:
  • Phone: 810-956-9483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LYNDA ROSS
Title or Position: OWNER
Credential: MA, LPC-S, NCC
Phone: 810-956-9483