Provider Demographics
NPI:1861003014
Name:DYNAMIC ENGAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:DYNAMIC ENGAGEMENT GROUP LLC
Other - Org Name:LINDSAY GROSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHILLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-258-2951
Mailing Address - Street 1:780 W LAKE LANSING RD STE 100
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8452
Mailing Address - Country:US
Mailing Address - Phone:517-281-6359
Mailing Address - Fax:517-323-9531
Practice Address - Street 1:780 W LAKE LANSING RD STE 100
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8452
Practice Address - Country:US
Practice Address - Phone:517-281-6359
Practice Address - Fax:517-323-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780954180Medicaid