Healthcare Provider Details

I. General information

NPI: 1467262709
Provider Name (Legal Business Name): JOSHUA THOMAS HARMON LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 KRAFT AVE SE STE 186
GRAND RAPIDS MI
49512-2076
US

IV. Provider business mailing address

2828 KRAFT AVE SE STE 186
GRAND RAPIDS MI
49512-2076
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-9550
  • Fax:
Mailing address:
  • Phone: 616-949-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: