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General NPI Number Information
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NPI Number | 1144580077
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Entity Type | Organization
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Legal Business Name | ISETHENA PRESS LLC
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Dates
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Enumeration Date | 05/25/2012
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 233 FULTON ST E SUITE 126
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-3200
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Country | US
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Telephone | 616-218-9903
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Fax | 616-459-9059
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Provider Business Mailing Address
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Address Line | PO BOX 1767
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City | GRAND RAPIDS
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State | MI
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Zip | 49501-1767
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Country | US
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Telephone | 616-235-2090
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Fax | 616-235-2099
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Authorized Official
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Title or Position | OWNER
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Name | TRACY M MCGEE
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Credential | MA LLP
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Telephone | 616-218-9903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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