Individual
CHANON SETHABUTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
5030 NORTHWIND DR STE 101, EAST LANSING, MI 48823-5034
(517) 333-1499
Mailing address
1210 S US HIGHWAY 27 APT 7, SAINT JOHNS, MI 48879-2440
(503) 858-5769
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401225145
MI
101YP2500X
Professional Counselor
6451022184
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6451022184
STATE OF MICHIGAN
MI
Enumeration date
08/16/2022
Last updated
06/05/2025
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