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General NPI Number Information
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NPI Number | 1396685335
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Entity Type | Organization
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Legal Business Name | UP CISM, PLLC
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 5026 COUNTY 426 21ST RD
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City | GLADSTONE
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State | MI
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Zip | 49837-9100
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Country | US
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Telephone | 906-241-3234
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Fax |
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Provider Business Mailing Address
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Address Line | 5026 COUNTY 426 21ST RD
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City | GLADSTONE
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State | MI
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Zip | 49837-9100
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Country | US
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Telephone | 906-241-3234
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | MARK E HALLFRISCH
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Credential | MSW
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Telephone | 906-241-3234
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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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