Healthcare Provider Details

I. General information

NPI: 1245651405
Provider Name (Legal Business Name): WMT INC. RECOVERY & HOUSING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 COMMERCE ST
MUSKEGON MI
49441-2608
US

IV. Provider business mailing address

2333 JARMAN ST
MUSKEGON MI
49444-1655
US

V. Phone/Fax

Practice location:
  • Phone: 231-728-2138
  • Fax: 231-722-4771
Mailing address:
  • Phone: 231-739-6840
  • Fax: 231-722-4771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberSA0610022
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberSA0610022
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberSA0610022
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberSA0610022
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberSA0610022
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberSA0610022
License Number StateMI

VIII. Authorized Official

Name: MR. LOUIS CHURCHWELL
Title or Position: CEO
Credential:
Phone: 231-728-2138