Healthcare Provider Details

I. General information

NPI: 1184133308
Provider Name (Legal Business Name): THE NEXT STEP PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 NORTH ST
ALLEGAN MI
49010-1172
US

IV. Provider business mailing address

1832 EMERALD AVE NE
GRAND RAPIDS MI
49505-4823
US

V. Phone/Fax

Practice location:
  • Phone: 616-325-5755
  • Fax:
Mailing address:
  • Phone: 616-325-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSA0030042
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY H HAYATAKA
Title or Position: OWNER
Credential:
Phone: 616-325-5755