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General NPI Number Information
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NPI Number | 1023700903
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Entity Type | Organization
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Legal Business Name | MELANIE FUENTES HOLISTIC THERAPY LLC
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 751 KENMOOR AVE SE STE D
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2391
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Country | US
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Telephone | 616-405-9482
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Fax |
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Provider Business Mailing Address
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Address Line | 1165 GRISWOLD ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-3812
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Country | US
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Telephone | 616-405-9482
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MELANIE JEWEL FUENTES
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Credential | LMSW
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Telephone | 616-405-9482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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