Healthcare Provider Details

I. General information

NPI: 1043945546
Provider Name (Legal Business Name): MELISSA ARIANNA RICHMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 GRAND RIDGE CT NE STE 200
GRAND RAPIDS MI
49525-7043
US

IV. Provider business mailing address

1715 N 5TH ST
NILES MI
49120-1290
US

V. Phone/Fax

Practice location:
  • Phone: 616-426-9034
  • Fax:
Mailing address:
  • Phone: 630-439-4407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451022337
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: