Healthcare Provider Details

I. General information

NPI: 1790024834
Provider Name (Legal Business Name): HEARTWOOD COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2013
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 ASHVILLE DR NE
GRAND RAPIDS MI
49525-3002
US

IV. Provider business mailing address

518 HOUSEMAN AVE NE
GRAND RAPIDS MI
49503-1828
US

V. Phone/Fax

Practice location:
  • Phone: 616-920-0245
  • Fax:
Mailing address:
  • Phone: 616-920-0245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086413
License Number StateMI

VIII. Authorized Official

Name: TRICIA MEEUWSEN
Title or Position: OWNER/COUNSELOR
Credential:
Phone: 616-920-0245