MEDICARE: TRANSCENDING TRAUMA INSTITUTE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	102L00000X	Psychoanalyst
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083331664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSCENDING TRAUMA INSTITUTE, PLLC

Provider Business Mailing Address
First Line	:	40315 MICHIGAN AVE # 1234
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-2908
Country	:	US
Telephone Number	:	734-353-1463
Fax Number	:	734-293-0264

Provider Business Practice Location Address
First Line	:	40315 MICHIGAN AVE # 1234
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-2908
Country	:	US
Telephone Number	:	734-353-1463
Fax Number	:	734-293-0264

Authorized Official
Title or Position	:	OWNER/CEO/CLINICAL PSYCHOTHERAPIST
Name	:	CHELSEA LAPIERA SUDDERTH
Credential	:	MSW, LMSW
Telephone Number	:	734-353-1463

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/22/2023

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