Healthcare Provider Details

I. General information

NPI: 1831898691
Provider Name (Legal Business Name): LUIS VALENCIA OSORIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 KOLLEN PARK DR
HOLLAND MI
49423-3401
US

IV. Provider business mailing address

265 KOLLEN PARK DR
HOLLAND MI
49423-3401
US

V. Phone/Fax

Practice location:
  • Phone: 616-300-4808
  • Fax:
Mailing address:
  • Phone: 616-212-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: