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General NPI Number Information
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NPI Number | 1114165438
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Entity Type | Organization
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Legal Business Name | MIDTOWN COUNSELING SERVICES
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Dates
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Enumeration Date | 01/23/2009
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Last Update Date | 04/25/2014
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Provider Practice Location Address
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Address Line | 96 W 15TH ST STE 208-9
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City | HOLLAND
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State | MI
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Zip | 49423-3370
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Country | US
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Telephone | 616-990-4441
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Fax |
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Provider Business Mailing Address
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Address Line | 96 W 15TH ST STE 208-9
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City | HOLLAND
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State | MI
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Zip | 49423-3370
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Country | US
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Telephone | 616-990-4441
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SUSAN RENEE VANWYNGARDEN
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Credential | M.A, L.P.C
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Telephone | 616-990-4441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6401010773
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License Number State | MI
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