Healthcare Provider Details

I. General information

NPI: 1093640096
Provider Name (Legal Business Name): GISELLE GRACE STRADER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E BIG BEAVER RD STE 100
TROY MI
48083-1216
US

IV. Provider business mailing address

215 E BIG BEAVER RD STE 100
TROY MI
48083-1216
US

V. Phone/Fax

Practice location:
  • Phone: 313-451-3315
  • Fax:
Mailing address:
  • Phone: 313-451-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025018
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: