Healthcare Provider Details

I. General information

NPI: 1982956231
Provider Name (Legal Business Name): DANIEL RYAN ZOMERLEI PH.D, MDIV, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 GARDEN AVE STE 110
HOLLAND MI
49424-8999
US

IV. Provider business mailing address

388 GARDEN AVE STE 110
HOLLAND MI
49424-8999
US

V. Phone/Fax

Practice location:
  • Phone: 616-222-0631
  • Fax: 616-222-0631
Mailing address:
  • Phone: 616-222-0631
  • Fax: 616-222-0631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006532
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: