Healthcare Provider Details

I. General information

NPI: 1003482035
Provider Name (Legal Business Name): SEED TO TREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 MAYFIELD ST
PORTAGE MI
49002-5513
US

IV. Provider business mailing address

PO BOX 1701
PORTAGE MI
49081-1701
US

V. Phone/Fax

Practice location:
  • Phone: 269-377-2485
  • Fax:
Mailing address:
  • Phone: 269-218-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. SARAH HAYES
Title or Position: OWNER, LPC
Credential:
Phone: 269-218-0115