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Organization
BY MOONLIGHT AND TIDE PSYCHOTHERAPY PLLC
Active
Organization
BY MOONLIGHT AND TIDE PSYCHOTHERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASSIANN M PROCENKO LMSW-C (CLINICAL DIRECTOR)
(320) 310-8895
Entity
Organization
Contact information
Practice address
2222 W GRAND RIVER AVE STE A, OKEMOS, MI 48864-1604
(248) 266-0625
Mailing address
740 KIMBERLY APT 302, LAKE ORION, MI 48362-2963
(320) 310-8895
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/15/2025
Last updated
05/15/2025
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