Healthcare Provider Details

I. General information

NPI: 1942036165
Provider Name (Legal Business Name): HANEEF TAUHEED HAMEED MUHAMMAD TLLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2774 BIRCHCREST DR SE
GRAND RAPIDS MI
49506-5477
US

IV. Provider business mailing address

3852 CAMELOT DR SE
GRAND RAPIDS MI
49546-6004
US

V. Phone/Fax

Practice location:
  • Phone: 616-329-3264
  • Fax:
Mailing address:
  • Phone: 616-329-3264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: