Provider Demographics
NPI:1598208092
Name:SHORELINE THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:SHORELINE THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-557-5319
Mailing Address - Street 1:116 W COLBY ST
Mailing Address - Street 2:SUITE B2
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-1083
Mailing Address - Country:US
Mailing Address - Phone:231-557-5319
Mailing Address - Fax:
Practice Address - Street 1:116 W COLBY ST
Practice Address - Street 2:SUITE B2
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1083
Practice Address - Country:US
Practice Address - Phone:231-557-5319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801073168251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health