Provider Demographics
NPI:1508571522
Name:TREE OF LIFE SERVICES, LLC
Entity Type:Organization
Organization Name:TREE OF LIFE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BILLER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CHAUDOIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-334-8639
Mailing Address - Street 1:22621 EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2447
Mailing Address - Country:US
Mailing Address - Phone:734-334-8636
Mailing Address - Fax:
Practice Address - Street 1:22621 EUCLID ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2447
Practice Address - Country:US
Practice Address - Phone:734-334-8636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty