MEDICARE: BRIENNE HEIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor		IN

General Provider Information

NPI Number	:	1538557558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIENNE HEIM

Provider Business Mailing Address
First Line	:	2450 VAN OMMEN DR STE C
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-8085
Country	:	US
Telephone Number	:	616-350-7781
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 VAN OMMEN DR STE C
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-8085
Country	:	US
Telephone Number	:	616-350-7781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2014
Last Update Date	:	02/09/2022

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Directions to “ BRIENNE HEIM ” Practice Location

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