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General NPI Number Information
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NPI Number | 1285765214
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Entity Type | Organization
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Legal Business Name | CHRIST LIFE COUNSELING CENTER OF GRAND RAPIDS
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 150 ANN ST NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-6244
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Country | US
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Telephone | 616-365-8074
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Fax |
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Provider Business Mailing Address
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Address Line | 2899 W 136TH ST
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City | GRANT
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State | MI
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Zip | 49327-8804
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Country | US
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Telephone | 616-365-8074
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ROBERT CHARLES SPRATT
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Credential | LMSW
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Telephone | 616-365-8074
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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 |
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License Number State |
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