Healthcare Provider Details

I. General information

NPI: 1568041812
Provider Name (Legal Business Name): HEART IN BALANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 CASCADE WEST PKWY SE STE 245
GRAND RAPIDS MI
49546-2142
US

IV. Provider business mailing address

660 CASCADE WEST PKWY SE STE 245
GRAND RAPIDS MI
49546-2142
US

V. Phone/Fax

Practice location:
  • Phone: 616-591-4442
  • Fax:
Mailing address:
  • Phone: 616-591-4442
  • 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: MS. RACHEL JEANNE HIPP
Title or Position: PSYCHOTHERAPIST/OWNER
Credential: L.M.S.W.
Phone: 616-591-4442