Healthcare Provider Details

I. General information

NPI: 1609395888
Provider Name (Legal Business Name): MANDY GRENIER BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 310
TAWAS CITY MI
48764-0310
US

IV. Provider business mailing address

320 S 3RD ST
WEST BRANCH MI
48661-1334
US

V. Phone/Fax

Practice location:
  • Phone: 989-362-8636
  • Fax:
Mailing address:
  • Phone: 248-914-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: