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General NPI Number Information
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NPI Number | 1952965477
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Entity Type | Organization
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Legal Business Name | MY SERENITY MY LIFE PLLC
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 04/30/2019
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Provider Practice Location Address
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Address Line | 740 CENTER ST
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City | CLIO
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State | MI
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Zip | 48420-1148
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Country | US
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Telephone | 810-309-5362
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 CHATEAU DR
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City | FLINT
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State | MI
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Zip | 48504-1623
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Country | US
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Telephone | 810-309-5362
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | LYNN P PROCTOR
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Credential | LLMSW
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Telephone | 810-309-5362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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