Provider Demographics
NPI:1184393811
Name:MCCRANDALL THERAPY SERVICES LLC
Entity type:Organization
Organization Name:MCCRANDALL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-373-2867
Mailing Address - Street 1:12745 S SAGINAW ST, STE 806 #110
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439
Mailing Address - Country:US
Mailing Address - Phone:810-373-2867
Mailing Address - Fax:
Practice Address - Street 1:2394 WILLOWDALE DR
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-4850
Practice Address - Country:US
Practice Address - Phone:810-373-2867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)