Healthcare Provider Details

I. General information

NPI: 1427753615
Provider Name (Legal Business Name): UNFOLDING PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 CASCADE RD SE STE D
GRAND RAPIDS MI
49546-3808
US

IV. Provider business mailing address

6145 CRYSTAL DR
ALLENDALE MI
49401-9788
US

V. Phone/Fax

Practice location:
  • Phone: 616-275-4585
  • Fax:
Mailing address:
  • Phone:
  • 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: REBECCA MAY
Title or Position: SOLE MEMBER
Credential:
Phone: 616-275-4585