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General NPI Number Information
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NPI Number | 1922877638
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Entity Type | Organization
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Legal Business Name | SANDY SHORES BEHAVIORAL HEALTH SERVICES, PLLC
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Dates
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Enumeration Date | 12/21/2023
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 220 W WASHINGTON ST STE 130
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City | MARQUETTE
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State | MI
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Zip | 49855-4359
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Country | US
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Telephone | 906-266-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 111 AUTUMN TRL
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City | MARQUETTE
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State | MI
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Zip | 49855-9070
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Country | US
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Telephone | 312-513-8627
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HEATHER BUSSER-DEMARTE
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Credential | PSYD
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Telephone | 312-513-8627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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