Healthcare Provider Details

I. General information

NPI: 1457462582
Provider Name (Legal Business Name): JOHN ROGER HEYNS MA LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 S DESPELDER ST PSYCHOLOGICAL SERVICES CENTER LG
GRAND HAVEN MI
49417
US

IV. Provider business mailing address

1703 S DESPELDER ST PSYCHOLOGICAL SERVICES CENTER LG
GRAND HAVEN MI
49417
US

V. Phone/Fax

Practice location:
  • Phone: 616-842-1277
  • Fax: 616-842-4190
Mailing address:
  • Phone: 616-842-1277
  • Fax: 616-842-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801014887
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: