Healthcare Provider Details

I. General information

NPI: 1750591095
Provider Name (Legal Business Name): JACOBUS JOHANNES HAMMAN M.DIV, TH.M, PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S RIVER AVE
HOLLAND MI
49423-3144
US

IV. Provider business mailing address

274 MAPLE AVE
HOLLAND MI
49423-3241
US

V. Phone/Fax

Practice location:
  • Phone: 616-405-5019
  • Fax:
Mailing address:
  • Phone: 616-546-2599
  • Fax: 616-546-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: