Healthcare Provider Details

I. General information

NPI: 1821294851
Provider Name (Legal Business Name): NORTH KENT GUIDANCE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 NORTHLAND DR SUITE A
GRAND RAPIDS MI
49525-1040
US

IV. Provider business mailing address

5250 NORTHLAND DR SUITE A
GRAND RAPIDS MI
49525-1040
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-5001
  • Fax: 616-361-2166
Mailing address:
  • Phone: 616-361-5001
  • Fax: 616-361-2166

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: MARIANNE SKILLING
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 616-361-5001