Healthcare Provider Details

I. General information

NPI: 1205926649
Provider Name (Legal Business Name): GRACE ELAINE HASSLER LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GREEN ACRES
SANDUSKY MI
48471-1067
US

IV. Provider business mailing address

2355 W EDDY RD
SANDUSKY MI
48471-9652
US

V. Phone/Fax

Practice location:
  • Phone: 810-648-0398
  • Fax: 810-648-2322
Mailing address:
  • Phone: 810-672-9266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6802069711
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: