Healthcare Provider Details

I. General information

NPI: 1467829820
Provider Name (Legal Business Name): DIANE FINCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 N 10TH ST
KALAMAZOO MI
49009-5733
US

IV. Provider business mailing address

1485 REDSTOCK AVE
PORTAGE MI
49024-4266
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-4363
  • Fax:
Mailing address:
  • Phone: 269-599-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011442
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: