MEDICARE: SERENITY COUNSELING 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1548813512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY COUNSELING LLC

Provider Business Mailing Address
First Line	:	PO BOX 324
Second Line	:
City	:	GRAND JUNCTION
State	:	MI
Zip	:	49056-0324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	54320 COUNTY ROAD 388
Second Line	:
City	:	GRAND JCT
State	:	MI
Zip	:	49056-9272
Country	:	US
Telephone Number	:	269-363-2302
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFANNI MIELKE
Credential	:
Telephone Number	:	269-363-2302

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	02/26/2025

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Directions to “SERENITY COUNSELING LLC ” Practice Location

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