Healthcare Provider Details

I. General information

NPI: 1093572968
Provider Name (Legal Business Name): CENTERED SELF MENTAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HALL ST SW STE 112AB
GRAND RAPIDS MI
49503-5098
US

IV. Provider business mailing address

401 HALL ST SW STE 112
GRAND RAPIDS MI
49503-5098
US

V. Phone/Fax

Practice location:
  • Phone: 616-275-4855
  • Fax:
Mailing address:
  • Phone: 616-275-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH SWEETBRASS
Title or Position: MANAGER
Credential:
Phone: 616-275-4855