Healthcare Provider Details

I. General information

NPI: 1568231603
Provider Name (Legal Business Name): LYNDSEY HANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 E 24TH ST STE 201
HOLLAND MI
49423-4973
US

IV. Provider business mailing address

14720 VALLEY VIEW AVE
HOLLAND MI
49424-6328
US

V. Phone/Fax

Practice location:
  • Phone: 616-217-9934
  • Fax:
Mailing address:
  • Phone: 616-422-2387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451023896
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: