Healthcare Provider Details

I. General information

NPI: 1003533845
Provider Name (Legal Business Name): THE CENTRE A MENTAL HEALTH COMPANY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 E SAVIDGE ST STE 5
SPRING LAKE MI
49456-1957
US

IV. Provider business mailing address

2319 BLOOMFIELD CT
NORTON SHORES MI
49441-4472
US

V. Phone/Fax

Practice location:
  • Phone: 616-935-2151
  • Fax: 616-469-1822
Mailing address:
  • Phone: 616-935-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL ROBERT MICHURA JR.
Title or Position: MANAGER
Credential:
Phone: 616-935-2151