Provider Demographics
NPI:1003568262
Name:TIRRELL, SACELIA MARIE
Entity Type:Individual
Prefix:
First Name:SACELIA
Middle Name:MARIE
Last Name:TIRRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 PORTAGE PATH
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2034
Mailing Address - Country:US
Mailing Address - Phone:616-634-2923
Mailing Address - Fax:
Practice Address - Street 1:1302 PORTAGE PATH
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2034
Practice Address - Country:US
Practice Address - Phone:256-945-8581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician