OrganizationActive
By Moonlight and Tide Psychotherapy PLLC
NPI 1912798174 · Mental Health Clinic/Center (Including Community Mental Health Center) · Okemos, MI
Provider details
- NPI number
- 1912798174
- Entity type
- Organization
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)Ambulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Cassiann Procenko, Clinical Director(320) 310-8895
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Established profile(59/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
1 yr in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2222 W Grand River Ave Ste a
Okemos, MI 48864-1604
Phone: (248) 266-0625
Street-level locationGet directions
Mailing address
740 Kimberly Apt 302
Lake Orion, MI 48362-2963
Additional practice locations (1)
- 740 Kimberly Apt 302Lake Orion, MI 48362-2963Phone: (248) 266-0625
Registry dates
- Enumerated
- 2025-05-15
- Last updated
- 2025-05-15
- Certified
- 2025-05-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.