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General NPI Number Information
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NPI Number | 1275998049
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Entity Type | Organization
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Legal Business Name | HOLISTIC COUNSELING SERVICES
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 2524 WOODMEADOW DR SE STE. 1
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8051
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Country | US
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Telephone | 616-862-3296
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Fax | 616-466-7944
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Provider Business Mailing Address
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Address Line | 2524 WOODMEADOW DR SE STE. 1
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8051
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Country | US
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Telephone | 616-862-3296
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Fax | 616-466-7944
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | DEBORAH LYNN JANDLE
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Credential | L.M.S.W.
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Telephone | 616-862-3296
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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 | 6801082338
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License Number State | MI
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