=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588485759
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STORIES UNFOLD COUNSELING SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2024
-----------------------------------------------------
Last Update Date | 10/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45200 STERRITT ST STE 204
-----------------------------------------------------
City | UTICA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48317-5844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-666-3392
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45100 STERRITT ST STE 204
-----------------------------------------------------
City | UTICA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48317-5847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER/THERAPIST
-----------------------------------------------------
Name | MISS KATHLEEN MCMAHON
-----------------------------------------------------
Credential | MA, LPC
-----------------------------------------------------
Telephone | 586-666-3392
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------