Healthcare Provider Details

I. General information

NPI: 1306237961
Provider Name (Legal Business Name): HOOM HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 MONROE AVE NW UNIT 354
GRAND RAPIDS MI
49503-1456
US

IV. Provider business mailing address

940 MONROE AVE NW UNIT 354
GRAND RAPIDS MI
49503-1456
US

V. Phone/Fax

Practice location:
  • Phone: 248-464-4770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-10017
License Number StateMI

VIII. Authorized Official

Name: MS. LAUREN MAE HOOMAIAN
Title or Position: FOUNDER
Credential: MS, BCBA
Phone: 248-464-4770