| Mustard Seed Family Counseling | |
|
33200 Dequindre Rd Ste 100 Sterling Heights MI 48310-5967 | |
| (586) 354-1489 | |
| (586) 803-4289 |
| Full Name | Mustard Seed Family Counseling |
|---|---|
| Speciality | Counselor |
| Location | 33200 Dequindre Rd Ste 100, Sterling Heights, Michigan |
| Authorized Official Name and Position | Lyana Hattar (CHIEF EXECUTIVE OFFICER (CEO)) |
| Authorized Official Contact | 5863541489 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mustard Seed Family Counseling Po Box 182399 Shelby Township MI 48318-2399 Ph: (586) 354-1489 | Mustard Seed Family Counseling 33200 Dequindre Rd Ste 100 Sterling Heights MI 48310-5967 Ph: (586) 354-1489 |
| NPI Number | 1366905408 |
|---|---|
| Provider Enumeration Date | 04/06/2019 |
| Last Update Date | 12/11/2023 |
| Certification Date | 12/11/2023 |
| Medicare PECOS PAC ID | 3870913361 |
|---|---|
| Medicare Enrollment ID | O20201022000985 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366905408 | NPI | - | NPPES |
| 1366905408 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Donald Sallee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053798025 PECOS PAC ID: 1052632155 Enrollment ID: I20150601002588 |
| Provider Name | Patrick Joseph Laus |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346649324 PECOS PAC ID: 0446505564 Enrollment ID: I20180613002595 |
| Provider Name | Gregory Richard Waltz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811659592 PECOS PAC ID: 3971953845 Enrollment ID: I20231219002567 |
| Provider Name | Lyana Victoria Hattar |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730335647 PECOS PAC ID: 7113206046 Enrollment ID: I20231220002877 |
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