MEDICARE: IN SEASON HOLISTIC CARE SERVICES 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	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1942881438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN SEASON HOLISTIC CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	17652 MONTAGE
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-3807
Country	:	US
Telephone Number	:	313-655-6277
Fax Number	:

Provider Business Practice Location Address
First Line	:	17652 MONTAGE
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-3807
Country	:	US
Telephone Number	:	313-655-6277
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CLARISSE M CARTER
Credential	:	NP-BC
Telephone Number	:	313-655-6277

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	04/23/2021

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