Healthcare Provider Details

I. General information

NPI: 1508444233
Provider Name (Legal Business Name): MMW THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 RICHARDS AVE NW
GRAND RAPIDS MI
49504-5453
US

IV. Provider business mailing address

68 RICHARDS AVE NW
GRAND RAPIDS MI
49504-5453
US

V. Phone/Fax

Practice location:
  • Phone: 616-389-0872
  • Fax:
Mailing address:
  • Phone: 714-720-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MONICA MARIE WILLSON
Title or Position: OWNER, THERAPSIT
Credential: LMFT
Phone: 714-720-8325