Healthcare Provider Details

I. General information

NPI: 1982203485
Provider Name (Legal Business Name): BECOMING YOU THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2346 MISSION HILLS DR SE
GRAND RAPIDS MI
49546-7804
US

IV. Provider business mailing address

4310 LEONARD ST NW STE 103
WALKER MI
49534-8447
US

V. Phone/Fax

Practice location:
  • Phone: 616-259-5444
  • Fax:
Mailing address:
  • Phone:
  • 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: MARIE DERSHEM
Title or Position: OWNER
Credential: LMSW
Phone: 616-259-5444