Healthcare Provider Details

I. General information

NPI: 1508228966
Provider Name (Legal Business Name): WEST MICHIGAN EMDR THERAPY AND CONSULTING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 LOOKOUT RDG
MESQUITE NV
89034-1195
US

IV. Provider business mailing address

1034 LOOKOUT RDG
MESQUITE NV
89034-1195
US

V. Phone/Fax

Practice location:
  • Phone: 616-920-0823
  • Fax:
Mailing address:
  • Phone: 616-920-0823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY ELLEN R BERTLING-SAFFORD
Title or Position: OWNER
Credential: LPC
Phone: 616-920-0823