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General NPI Number Information
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NPI Number | 1316557523
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Entity Type | Organization
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Legal Business Name | TRI-CITIES DBT & TRAUMA
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 1807 SYLVAN LN
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City | MIDLAND
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State | MI
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Zip | 48640-6760
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Country | US
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Telephone | 989-906-0433
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Fax |
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Provider Business Mailing Address
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Address Line | 240 W MAIN ST STE 2600
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City | MIDLAND
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State | MI
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Zip | 48640-5191
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Country | US
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Telephone | 989-906-0433
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | MRS. SARA GRACE KNUTSON
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Credential | LPC
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Telephone | 989-906-0433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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