Healthcare Provider Details

I. General information

NPI: 1396557575
Provider Name (Legal Business Name): MY FAVORITE THERAPIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 OAK INDUSTRIAL DR NE STE 209
GRAND RAPIDS MI
49505-6037
US

IV. Provider business mailing address

3393 ENGLISH HILLS DR NW
GRAND RAPIDS MI
49544-7334
US

V. Phone/Fax

Practice location:
  • Phone: 269-340-1116
  • Fax:
Mailing address:
  • Phone: 269-340-1116
  • 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: JASMIN STEPHENS
Title or Position: OWNER
Credential: LMSW
Phone: 269-340-1116