Healthcare Provider Details

I. General information

NPI: 1245756097
Provider Name (Legal Business Name): LOANNA ABREU PEREZ MA, TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MONROE AVE NW
GRAND RAPIDS MI
49503-1455
US

IV. Provider business mailing address

1000 MONROE AVE NW
GRAND RAPIDS MI
49503-1455
US

V. Phone/Fax

Practice location:
  • Phone: 616-259-7207
  • Fax:
Mailing address:
  • Phone: 616-259-7207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6362007702
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: