MEDICARE: SWEET SERENITY BEHAVIORAL HEALTH AND LIFE COACHING LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245942275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWEET SERENITY BEHAVIORAL HEALTH AND LIFE COACHING LLC

Provider Business Mailing Address
First Line	:	20987 N JOHN WAYNE PKWY # B103-113
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85139-2926
Country	:	US
Telephone Number	:	520-251-1575
Fax Number	:	520-635-4758

Provider Business Practice Location Address
First Line	:	24225 W 9 MILE RD STE 3099
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3962
Country	:	US
Telephone Number	:	520-251-1575
Fax Number	:	520-635-4758

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CAMILLA WILLIAMS
Credential	:
Telephone Number	:	267-901-8612

Provider Enumeration Date	:	12/21/2022
Last Update Date	:	12/30/2022

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