Provider Demographics
NPI:1093273377
Name:LARCH TREE COUNSELING AND WELLNESS LLC
Entity Type:Organization
Organization Name:LARCH TREE COUNSELING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-673-1441
Mailing Address - Street 1:611 PINE ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3165
Mailing Address - Country:US
Mailing Address - Phone:231-929-2612
Mailing Address - Fax:888-599-0120
Practice Address - Street 1:1515 CASS ST STE D
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4156
Practice Address - Country:US
Practice Address - Phone:231-929-2612
Practice Address - Fax:888-599-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty