Healthcare Provider Details

I. General information

NPI: 1790487098
Provider Name (Legal Business Name): BRITTANY DYKSTRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 E 16TH ST
HOLLAND MI
49423-3786
US

IV. Provider business mailing address

675 E 16TH ST
HOLLAND MI
49423-3786
US

V. Phone/Fax

Practice location:
  • Phone: 616-990-2310
  • Fax: 616-258-2248
Mailing address:
  • Phone: 616-990-2310
  • Fax: 616-258-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: