Healthcare Provider Details

I. General information

NPI: 1306533385
Provider Name (Legal Business Name): PUERTAS ABIERTAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 MONROE AVE NW STE 206
GRAND RAPIDS MI
49505-4663
US

IV. Provider business mailing address

1345 MONROE AVE NW STE 206
GRAND RAPIDS MI
49505-4663
US

V. Phone/Fax

Practice location:
  • Phone: 616-690-8267
  • Fax:
Mailing address:
  • Phone: 616-690-8267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SILVIA ANDREA INOSTROZA
Title or Position: PROVIDER
Credential: LLPCC
Phone: 616-690-8267