Healthcare Provider Details

I. General information

NPI: 1336642149
Provider Name (Legal Business Name): BARNES THERAPY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1010
US

IV. Provider business mailing address

4920 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1010
US

V. Phone/Fax

Practice location:
  • Phone: 616-690-3986
  • Fax:
Mailing address:
  • Phone: 616-690-3986
  • 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: MRS. MELISSA BARNES
Title or Position: THERAPIST
Credential: LMSW
Phone: 616-690-3986