Healthcare Provider Details

I. General information

NPI: 1497351894
Provider Name (Legal Business Name): THERAPY CENTER FOR BEHAVIORAL HEALTH AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 RAYBROOK ST SE STE 202
GRAND RAPIDS MI
49546-7717
US

IV. Provider business mailing address

2020 RAYBROOK ST SE STE 202
GRAND RAPIDS MI
49546-7717
US

V. Phone/Fax

Practice location:
  • Phone: 616-285-6777
  • Fax: 616-285-6063
Mailing address:
  • Phone: 616-285-6777
  • Fax: 616-285-6063

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: REBECCA THOMPSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 616-285-6777