Lost Lake Healing
Social Worker, Clinical in Remus, MI. Organization (NPI-2).
NPI number1104732155
StatusActive
Last updated in NPPESSep 19, 2026
Details
- NPI
- 1104732155
- Entity type
- Organization (NPI-2)
- Legal business name
- Lost Lake Healing
- Organization subpart
- No
- Enumeration date
- Aug 20, 2026
- Certification date
- Sep 19, 2026
- Last updated
- Sep 19, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | – | – | Yes |
Practice location
13419 Swistier DrRemus, MI 49340-9381
Phone 231-408-7866
Mailing address
13419 Swistier DrRemus, MI 49340-9381
Phone 231-408-7866
Authorized official
McKenna Jo Nivison
Owner/Outpatient Therapist
2314087866
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