Healthcare Provider Details

I. General information

NPI: 1477885325
Provider Name (Legal Business Name): WILSON AND WYNN INTERVENTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 THREE MILE NW SUITE 150
GRAND RAPIDS MI
49544
US

IV. Provider business mailing address

1148 ORCHARD AVE SE
GRAND RAPIDS MI
49506-3547
US

V. Phone/Fax

Practice location:
  • Phone: 616-647-3460
  • Fax:
Mailing address:
  • Phone: 616-855-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TIM GERARD LEONARD
Title or Position: THERAPIST
Credential:
Phone: 616-855-5151