| By Moonlight And Tide Psychotherapy Pllc | |
|
2222 W Grand River Ave Ste A Okemos MI 48864-1604 | |
| (248) 266-0625 | |
| Not Available |
| Full Name | By Moonlight And Tide Psychotherapy Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2222 W Grand River Ave Ste A, Okemos, Michigan |
| Authorized Official Name and Position | Cassiann M Procenko (CLINICAL DIRECTOR) |
| Authorized Official Contact | 3203108895 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| By Moonlight And Tide Psychotherapy Pllc 740 Kimberly Apt 302 Lake Orion MI 48362-2963 Ph: (320) 310-8895 | By Moonlight And Tide Psychotherapy Pllc 2222 W Grand River Ave Ste A Okemos MI 48864-1604 Ph: (248) 266-0625 |
| NPI Number | 1912798174 |
|---|---|
| Provider Enumeration Date | 05/15/2025 |
| Last Update Date | 05/15/2025 |
| Certification Date | 05/15/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912798174 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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