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General NPI Number Information
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NPI Number | 1477195246
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Entity Type | Organization
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Legal Business Name | EPIC DISCOVERIES LLC
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 10/14/2019
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Provider Practice Location Address
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Address Line | 4867 E. BELTLINE AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525
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Country | US
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Telephone | 616-219-0304
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Fax |
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Provider Business Mailing Address
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Address Line | 6059 BREWER AVE NE
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City | BELMONT
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State | MI
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Zip | 49306-9653
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Country | US
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Telephone | 616-292-4594
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MR. RUEBEN JOSEPH LOPEZ
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Credential | LPC
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Telephone | 616-292-4594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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