Healthcare Provider Details

I. General information

NPI: 1053959668
Provider Name (Legal Business Name): BIRCHWOOD COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 MICHIGAN ST NE STE 7
GRAND RAPIDS MI
49503-2028
US

IV. Provider business mailing address

1444 MICHIGAN ST NE STE 7
GRAND RAPIDS MI
49503-2028
US

V. Phone/Fax

Practice location:
  • Phone: 248-894-8421
  • Fax:
Mailing address:
  • Phone: 248-894-8421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY JANSMA
Title or Position: DIRECTOR
Credential: LPC
Phone: 248-894-8421