Healthcare Provider Details

I. General information

NPI: 1215395017
Provider Name (Legal Business Name): ORCHARD HILL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 3 MILE RD NW
GRAND RAPIDS MI
49544-1614
US

IV. Provider business mailing address

1465 3 MILE RD NW
GRAND RAPIDS MI
49544-1614
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-5095
  • Fax: 616-784-4410
Mailing address:
  • Phone: 616-784-5095
  • Fax: 616-784-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014678
License Number StateMI

VIII. Authorized Official

Name: AARON VAN MANEN
Title or Position: DIRECTOR OF COUNSELING
Credential: LLPC
Phone: 616-784-5095