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General NPI Number Information
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NPI Number | 1225668684
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Entity Type | Organization
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Legal Business Name | EXPRESSIVE EXPLORATIONS
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 2050 BRETON RD SE STE 104
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-5547
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Country | US
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Telephone | 616-259-5136
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Fax | 616-345-1317
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Provider Business Mailing Address
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Address Line | 3232 WOODWARD AVE SW
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City | WYOMING
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State | MI
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Zip | 49509-3038
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Country | US
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Telephone | 616-259-5136
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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. ANNALISE HAMMERLUND
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Credential | LPC
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Telephone | 616-259-5136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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