Healthcare Provider Details

I. General information

NPI: 1669993283
Provider Name (Legal Business Name): RENEWED CLARITY COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 07/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2663 44TH ST SW STE 106
WYOMING MI
49519-4189
US

IV. Provider business mailing address

7400 EMERALD WOODS DR SE
BYRON CENTER MI
49315-8977
US

V. Phone/Fax

Practice location:
  • Phone: 616-822-5518
  • Fax:
Mailing address:
  • Phone: 616-822-5518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6401007890
License Number StateMI

VIII. Authorized Official

Name: MRS. MELISSA LYNN VANDER KOOI
Title or Position: OWNER/THERAPIST
Credential: LPC
Phone: 616-822-5518