Healthcare Provider Details

I. General information

NPI: 1952196677
Provider Name (Legal Business Name): SOMATIC INTEGRATIVE THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2025
Last Update Date: 04/12/2025
Certification Date: 04/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 RAYBROOK ST SE STE 104C
GRAND RAPIDS MI
49546-7717
US

IV. Provider business mailing address

18 CALEDONIA ST NE
GRAND RAPIDS MI
49505-4902
US

V. Phone/Fax

Practice location:
  • Phone: 616-325-3389
  • Fax:
Mailing address:
  • Phone: 616-325-3389
  • 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: ALEXIS N MILLER
Title or Position: PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 616-325-3389