Healthcare Provider Details

I. General information

NPI: 1104579473
Provider Name (Legal Business Name): HEAL-ENCOURAGE-MOTIVATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 12/28/2023
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E BELTLINE AVE SE
GRAND RAPIDS MI
49546-7630
US

IV. Provider business mailing address

2025 E BELTLINE AVE SE STE 102
GRAND RAPIDS MI
49546-7673
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-6542
  • Fax:
Mailing address:
  • Phone: 616-202-6542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAHLEEKAH PARTEE-YOUNG
Title or Position: MENTAL HEALTH PRACTITIONER
Credential: LMSW
Phone: 616-202-6542