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General NPI Number Information
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NPI Number | 1427539543
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Entity Type | Organization
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Legal Business Name | GRAND HAVEN COUNSELING LLC
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 1703 S DESPELDER ST
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2649
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Country | US
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Telephone | 616-901-6967
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Fax |
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Provider Business Mailing Address
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Address Line | 1703 S DESPELDER ST
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2649
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Country | US
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Telephone | 616-901-6967
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEREMY WIERSMA
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Credential |
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Telephone | 616-901-6967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401015173
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License Number State | MI
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