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General NPI Number Information
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NPI Number | 1063263614
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Entity Type | Organization
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Legal Business Name | CALM TIDES THERAPY
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 112 S MAIN ST
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City | MOUNT PLEASANT
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State | MI
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Zip | 48858-2326
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Country | US
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Telephone | 989-802-4422
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Fax |
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Provider Business Mailing Address
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Address Line | 4544 E LAPORTE RD
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City | FREELAND
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State | MI
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Zip | 48623-9104
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Country | US
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Telephone | 989-802-4422
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | KIRSTEN LOUISE THAYER
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Credential | LMSW
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Telephone | 989-802-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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