Healthcare Provider Details

I. General information

NPI: 1972067189
Provider Name (Legal Business Name): MARTHA VELTING THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 FULTON ST E STE 524
GRAND RAPIDS MI
49503-3200
US

IV. Provider business mailing address

363 BALL PARK BLVD NW
GRAND RAPIDS MI
49504-4908
US

V. Phone/Fax

Practice location:
  • Phone: 616-460-9544
  • Fax:
Mailing address:
  • Phone: 616-460-9544
  • 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. MARTHA CAROLE SORENSON VELTING
Title or Position: CLINICAL SOCIAL WORKER
Credential: LMSW
Phone: 616-460-9544