Provider Demographics
NPI:1174255830
Name:TAMMY SUE WILSON
Entity Type:Organization
Organization Name:TAMMY SUE WILSON
Other - Org Name:RESILIENCE COUNSELING & PLAY THERAPY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, RPT, ICST
Authorized Official - Phone:810-637-1183
Mailing Address - Street 1:626 BUSHA HWY
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1310
Mailing Address - Country:US
Mailing Address - Phone:810-637-1183
Mailing Address - Fax:
Practice Address - Street 1:626 BUSHA HWY
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1310
Practice Address - Country:US
Practice Address - Phone:810-637-1183
Practice Address - Fax:810-637-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty