Healthcare Provider Details

I. General information

NPI: 1437357068
Provider Name (Legal Business Name): DAVID HARVEY KINSMAN SR. M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 36TH ST SE
GRAND RAPIDS MI
49512-2809
US

IV. Provider business mailing address

3055 NEW HOLLAND ST
HUDSONVILLE MI
49426-9413
US

V. Phone/Fax

Practice location:
  • Phone: 616-831-5655
  • Fax:
Mailing address:
  • Phone: 616-460-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number010288
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: