Provider Demographics
NPI:1053927350
Name:DEMSHUR, SALLY CATHERINE (LMFT)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:CATHERINE
Last Name:DEMSHUR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2534 LUPINE CT
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3366
Mailing Address - Country:US
Mailing Address - Phone:919-260-8612
Mailing Address - Fax:
Practice Address - Street 1:4295 OKEMOS RD STE 160
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6200
Practice Address - Country:US
Practice Address - Phone:616-765-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704220828163W00000X
MI4101007356106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse