| Sisu Michigan Llc | |
|
2222 W Grand River Ave Ste A Okemos MI 48864-1604 | |
| (989) 403-0192 | |
| Not Available |
| Full Name | Sisu Michigan Llc |
|---|---|
| Speciality | Counselor |
| Location | 2222 W Grand River Ave Ste A, Okemos, Michigan |
| Authorized Official Name and Position | Danyelle E Wagner (SOCIAL WORKER/ CEO) |
| Authorized Official Contact | 9894030192 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sisu Michigan Llc 1363 N Garfield Rd Linwood MI 48634-9759 Ph: (989) 751-7854 | Sisu Michigan Llc 2222 W Grand River Ave Ste A Okemos MI 48864-1604 Ph: (989) 403-0192 |
| NPI Number | 1972232122 |
|---|---|
| Provider Enumeration Date | 06/05/2022 |
| Last Update Date | 06/05/2022 |
| Certification Date | 06/05/2022 |
| Medicare PECOS PAC ID | 5294198248 |
|---|---|
| Medicare Enrollment ID | O20230824001018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972232122 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Danyelle E Barber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821407321 PECOS PAC ID: 2668885146 Enrollment ID: I20201229002589 |
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