Healthcare Provider Details

I. General information

NPI: 1649574294
Provider Name (Legal Business Name): NORTH KENT GUIDANCE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 NORTHLAND DR NE SUITE A
GRAND RAPIDS MI
49525-1096
US

IV. Provider business mailing address

5250 NORTHLAND DR NE SUITE A
GRAND RAPIDS MI
49525-1096
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-5001
  • Fax: 616-361-2166
Mailing address:
  • Phone: 616-361-5001
  • Fax: 616-361-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MARIANNE SKILLING
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 616-361-5001