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NPI Code Detail

MEDICARE: ALICIA KITSUSE LLC

MEDICARE: ALICIA KITSUSE 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
1101YP2500XProfessional Counselor6401225803MI

General Provider Information

NPI Number : 1629843057
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALICIA KITSUSE LLC
Provider Business Mailing Address
First Line : 127 N LAFAYETTE ST
Second Line :
City : SOUTH LYON
State : MI
Zip : 48178-1210
Country : US
Telephone Number : 248-573-7417
Fax Number :
Provider Business Practice Location Address
First Line : 127 N LAFAYETTE ST
Second Line :
City : SOUTH LYON
State : MI
Zip : 48178-1210
Country : US
Telephone Number : 248-573-7417
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2023
Last Update Date : 12/03/2025

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Directions to “ ALICIA KITSUSE LLC” Practice Location

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