Healthcare Provider Details

I. General information

NPI: 1538531017
Provider Name (Legal Business Name): LIFE JOURNEY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 EAST CASTLE DRIVE SW SUITE B
GRAND RAPIDS MI
49508
US

IV. Provider business mailing address

2013 EAST CASTLE DRIVE SW SUITE B
GRAND RAPIDS MI
49508
US

V. Phone/Fax

Practice location:
  • Phone: 616-888-1120
  • Fax: 616-469-1113
Mailing address:
  • Phone: 616-888-1060
  • Fax: 616-469-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301016514
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301016514
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301016514
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number6301016514
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number6301016514
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number6301016514
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6301016514
License Number StateMI
# 8
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301016514
License Number StateMI

VIII. Authorized Official

Name: DR. URMINDA SUE FIRLAN
Title or Position: PSYCHOLOGIST
Credential: PHD, DLLP
Phone: 616-901-9507