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General NPI Number Information
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NPI Number | 1396557575
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Entity Type | Organization
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Legal Business Name | MY FAVORITE THERAPIST LLC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 2215 OAK INDUSTRIAL DR NE STE 209
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-6037
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Country | US
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Telephone | 269-340-1116
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Fax |
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Provider Business Mailing Address
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Address Line | 3393 ENGLISH HILLS DR NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49544-7334
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Country | US
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Telephone | 269-340-1116
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASMIN STEPHENS
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Credential | LMSW
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Telephone | 269-340-1116
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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 |
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License Number State |
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