Healthcare Provider Details

I. General information

NPI: 1699274431
Provider Name (Legal Business Name): RYAN LEON TOWNES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49506-1214
US

IV. Provider business mailing address

2465 BYRON CENTER AVE SW
WYOMING MI
49519-2111
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-3660
  • Fax: 269-344-4459
Mailing address:
  • Phone: 269-365-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401018928
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: