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General NPI Number Information
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NPI Number | 1376820860
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Entity Type | Organization
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Legal Business Name | THETHIRDCHAIR
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 12/09/2016
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Provider Practice Location Address
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Address Line | 648 MONROE AVE NW SUITE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1452
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Country | US
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Telephone | 616-916-3711
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Fax | 616-825-6015
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Provider Business Mailing Address
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Address Line | 648 MONROE AVE NW SUITE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1452
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Country | US
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Telephone | 616-916-3711
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Fax | 616-825-6015
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Authorized Official
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Title or Position | DIRECTOR, FOUNDER
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Name | SCOTT MCKNIGHT
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Credential | LMSW
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Telephone | 616-916-3711
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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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