Healthcare Provider Details

I. General information

NPI: 1285861328
Provider Name (Legal Business Name): RATIONAL TRAINING CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 E PARIS AVE SE
GRAND RAPIDS MI
49546-6191
US

IV. Provider business mailing address

2525 E PARIS AVE SE
GRAND RAPIDS MI
49546-6191
US

V. Phone/Fax

Practice location:
  • Phone: 616-975-0139
  • Fax: 616-957-3124
Mailing address:
  • Phone:
  • Fax: 616-957-3124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801012603
License Number StateMI

VIII. Authorized Official

Name: MR. CLYDE POAG
Title or Position: PRESIDENT/CEO
Credential: MSW
Phone: 616-975-0139