Healthcare Provider Details

I. General information

NPI: 1255129813
Provider Name (Legal Business Name): TIDES EMOTIONAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

964 LAKESIDE DR SE
GRAND RAPIDS MI
49506-3404
US

IV. Provider business mailing address

1595 HILLSIDE DR
OKEMOS MI
48864-2319
US

V. Phone/Fax

Practice location:
  • Phone: 616-219-0782
  • Fax:
Mailing address:
  • Phone:
  • 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: HANNAH OLSON
Title or Position: OWNER AND THERAPIST
Credential: LCSW, LMSW
Phone: 616-219-0782