Provider Demographics
NPI:1306308440
Name:SERENITY THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:SERENITY THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MASTER'S SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-341-4371
Mailing Address - Street 1:1228 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-9725
Mailing Address - Country:US
Mailing Address - Phone:810-341-4371
Mailing Address - Fax:
Practice Address - Street 1:11831 MAPLE RD
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-8487
Practice Address - Country:US
Practice Address - Phone:810-350-9111
Practice Address - Fax:844-273-3696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty