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General NPI Number Information
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NPI Number | 1447831599
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Entity Type | Organization
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Legal Business Name | CENTER FOR TRAUMA RECOVERY AND COUNSELING
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 3501 FAIRLANES AVE SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-1535
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Country | US
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Telephone | 616-303-0222
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Fax |
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Provider Business Mailing Address
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Address Line | 3390 KETTLE RIVER CT SW
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City | WYOMING
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State | MI
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Zip | 49418-8825
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Country | US
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Telephone | 616-780-2833
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Fax |
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Authorized Official
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Title or Position | OWNER AND PSYCHOTHERAPIST
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Name | DR. JOSHUA BISHOP
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Credential | LMSW
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Telephone | 616-780-2833
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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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