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General NPI Number Information
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NPI Number | 1336711480
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Entity Type | Individual
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Provider Name | ISRAEL URIAS LEE OSTRANDER D-TLLP
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Gender | Male
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 6810 OLD 28TH ST SE STE 4
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6932
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Country | US
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Telephone | 616-264-5414
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Fax |
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Provider Business Mailing Address
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Address Line | 940 WISCONSIN AVE # 1
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-1538
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Country | US
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Telephone | 231-408-0526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6352001140
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License Number State | MI
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