Healthcare Provider Details

I. General information

NPI: 1508381740
Provider Name (Legal Business Name): REBECCA TURNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MONROE AVE NW STE 401
GRAND RAPIDS MI
49503-2211
US

IV. Provider business mailing address

1121 BRETON RD SE
GRAND RAPIDS MI
49506-3529
US

V. Phone/Fax

Practice location:
  • Phone: 616-888-1120
  • Fax:
Mailing address:
  • Phone: 616-446-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401003114
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: