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General NPI Number Information
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NPI Number | 1598483695
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Entity Type | Individual
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Provider Name | CHANON SETHABUTRA LPC
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Gender | Male
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 5030 NORTHWIND DR STE 101
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City | EAST LANSING
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State | MI
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Zip | 48823-5034
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Country | US
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Telephone | 517-333-1499
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 S US HIGHWAY 27 APT 7
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City | SAINT JOHNS
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State | MI
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Zip | 48879-2440
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Country | US
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Telephone | 503-858-5769
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451022184
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401225145
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License Number State | MI
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