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General NPI Number Information
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NPI Number | 1275130817
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Entity Type | Organization
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Legal Business Name | SISU WELLNESS AND COUNSELING, LLC
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Dates
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Enumeration Date | 10/06/2020
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 2780 CHARLEVOIX RD STE 13
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City | PETOSKEY
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State | MI
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Zip | 49770-8058
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Country | US
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Telephone | 231-881-2149
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Fax |
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Provider Business Mailing Address
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Address Line | 653 ALCAN DR
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City | PETOSKEY
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State | MI
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Zip | 49770-9622
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Country | US
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Telephone | 231-881-2149
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATRINA M TRIPP
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Credential | LMSW-CLINICAL
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Telephone | 231-881-2149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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