Healthcare Provider Details

I. General information

NPI: 1629604723
Provider Name (Legal Business Name): EMDR AND WELLNESS SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57239 N MAIN ST STE 1
THREE RIVERS MI
49093-9419
US

IV. Provider business mailing address

57239 N MAIN ST STE 1
THREE RIVERS MI
49093-9419
US

V. Phone/Fax

Practice location:
  • Phone: 269-273-0030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: BECKY NAGY
Title or Position: OWNER
Credential: PSYD
Phone: 269-350-7385