=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649198490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNDIAL MIND CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2026
-----------------------------------------------------
Last Update Date | 07/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 655 N 1ST ST
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48625-7726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-600-3236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 913 S SAGINAW RD STE 109
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48640-4602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-600-3236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | KARI NICOLE DIEDERICH
-----------------------------------------------------
Credential | CRNA, PMHNP-BC
-----------------------------------------------------
Telephone | 989-600-3236
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------