Provider Demographics
NPI:1275150070
Name:CIRCLE OF LIFE COUNSELING LLC
Entity Type:Organization
Organization Name:CIRCLE OF LIFE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETOSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC
Authorized Official - Phone:810-962-3556
Mailing Address - Street 1:3292 BELFAST STREET
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-1825
Mailing Address - Country:US
Mailing Address - Phone:810-962-3556
Mailing Address - Fax:810-963-8359
Practice Address - Street 1:G-6201 MILLER RD
Practice Address - Street 2:SUITE B
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1598
Practice Address - Country:US
Practice Address - Phone:810-962-3556
Practice Address - Fax:810-963-8953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty