Healthcare Provider Details

I. General information

NPI: 1508354465
Provider Name (Legal Business Name): MELISSA R TOWER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49525-9349
US

IV. Provider business mailing address

4829 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49525-9349
US

V. Phone/Fax

Practice location:
  • Phone: 866-752-2359
  • Fax:
Mailing address:
  • Phone: 866-752-2359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301010663
License Number StateMI

VIII. Authorized Official

Name: MELISSA R TOWER
Title or Position: PSYCHOTHERAPIST
Credential: MA, LLP
Phone: 616-443-5343