Healthcare Provider Details

I. General information

NPI: 1437610730
Provider Name (Legal Business Name): COUNSELING CENTER OF WEST MICHIGAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49506-1214
US

IV. Provider business mailing address

333 BRIDGE ST NW STE 1120
GRAND RAPIDS MI
49504-5356
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-3660
  • Fax: 616-808-3631
Mailing address:
  • Phone: 616-805-3660
  • Fax: 616-805-3631

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: SARAH E TIMMER
Title or Position: CLINICAL DIRECTOR
Credential: MA, LPC, LMFT, NCC
Phone: 616-805-3660