Provider Demographics
NPI:1598362998
Name:THE SUPPORT GROUP LLC
Entity Type:Organization
Organization Name:THE SUPPORT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-494-9057
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48805-0854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2698 HEATHER DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3830
Practice Address - Country:US
Practice Address - Phone:989-494-9057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty