Healthcare Provider Details

I. General information

NPI: 1487046546
Provider Name (Legal Business Name): JOSHUA NIEUWSMA LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2944 FULLER AVE NE
GRAND RAPIDS MI
49505-3784
US

IV. Provider business mailing address

805 LEONARD ST NE
GRAND RAPIDS MI
49503-1138
US

V. Phone/Fax

Practice location:
  • Phone: 616-916-9477
  • Fax:
Mailing address:
  • Phone: 616-916-9477
  • Fax: 616-361-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012528
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: