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General NPI Number Information
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NPI Number | 1114500964
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Entity Type | Organization
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Legal Business Name | SERENE ATTACHMENTS THERAPY PLLC
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Dates
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Enumeration Date | 04/29/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 160 DIVISION ST STE E
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City | COLDWATER
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State | MI
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Zip | 49036-2914
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Country | US
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Telephone | 517-677-0848
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Fax |
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Provider Business Mailing Address
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Address Line | 160 DIVISION ST STE E
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City | COLDWATER
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State | MI
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Zip | 49036-2914
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Country | US
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Telephone | 517-677-0848
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | ALEXANDER FRY
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Credential | MA, LMFT
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Telephone | 517-677-0848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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