Organization · Type 2 NPI

By Moonlight and Tide Psychotherapy PLLC

Mental Health Clinic/Center (Including Community Mental Health Center) · Okemos, MI

NPI number 1912798174 Active

Practice location

2222 W Grand River Ave Ste A
Okemos, MI 48864-1604

Mailing address

740 Kimberly Apt 302
Lake Orion, MI 48362-2963

Other practice locations

  • 740 Kimberly Apt 302, Lake Orion, MI 48362-2963 · (248) 266-0625

Specialties and licenses

TaxonomyCodeLicense
Mental Health Clinic/Center (Including Community Mental Health Center) Primary 261QM0801XNone listed

Mental Health Clinic/Center (Including Community Mental Health Center): Definition to come...

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About NPI 1912798174

By Moonlight and Tide Psychotherapy PLLC's National Provider Identifier is 1912798174, issued on May 15, 2025. The primary taxonomy on file is Mental Health Clinic/Center (Including Community Mental Health Center) (261QM0801X), and the practice location is in Okemos, MI. The record was last updated on May 15, 2025.