Healthcare Provider Details

I. General information

NPI: 1598208779
Provider Name (Legal Business Name): HALIE PORRITT CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 HUCKLEBERRY LN
LANSING MI
48917-8805
US

IV. Provider business mailing address

PO BOX 90002
WYOMING MI
49509-9919
US

V. Phone/Fax

Practice location:
  • Phone: 616-828-5492
  • Fax: 855-207-3270
Mailing address:
  • Phone: 616-828-5492
  • Fax: 855-207-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: