Healthcare Provider Details

I. General information

NPI: 1831235985
Provider Name (Legal Business Name): YWCA WEST CENTRAL MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SHELDON BLVD SE
GRAND RAPIDS MI
49503-4209
US

IV. Provider business mailing address

25 SHELDON BLVD SE
GRAND RAPIDS MI
49503-4209
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-4681
  • Fax: 616-459-5423
Mailing address:
  • Phone: 616-459-4681
  • Fax: 616-459-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBRA E SHIMMEL
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 616-459-4681