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General NPI Number Information
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NPI Number | 1104701119
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Entity Type | Individual
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Provider Name | EMMA MOYNIHAN
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Gender | Female
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 4867 E BELTLINE AVE NE BUILDING 1, STE 400
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City | GRAND RAPIDS
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State | MI
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Zip | 49525
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Country | US
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Telephone | 616-202-2253
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Fax |
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Provider Business Mailing Address
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Address Line | 6905 FOREST VALLEY DRIVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546
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Country | US
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Telephone | 708-334-9582
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6451024466
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License Number State | MI
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