Healthcare Provider Details

I. General information

NPI: 1487287678
Provider Name (Legal Business Name): TSEHAIA SANTA ANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W 16TH ST
HOLLAND MI
49423-3320
US

IV. Provider business mailing address

12154 LAKEVIEW ST APT 1B
HOLLAND MI
49424-7911
US

V. Phone/Fax

Practice location:
  • Phone: 616-772-1733
  • Fax:
Mailing address:
  • Phone: 407-924-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: