Healthcare Provider Details

I. General information

NPI: 1275646309
Provider Name (Legal Business Name): WEST MICHIGAN COMMUNITY MENTAL HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 DIANA ST
LUDINGTON MI
49431-1987
US

IV. Provider business mailing address

920 DIANA ST
LUDINGTON MI
49431-1987
US

V. Phone/Fax

Practice location:
  • Phone: 231-845-6294
  • Fax: 231-845-7095
Mailing address:
  • Phone: 231-845-6294
  • Fax: 231-845-7095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. RICH H. VANDENHEUVEL
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 231-845-6294