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General NPI Number Information
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NPI Number | 1508593005
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Entity Type | Organization
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Legal Business Name | REMEMBERED KNOWING THERAPY LLC
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 3181 PRAIRIE ST SW STE 114
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City | GRANDVILLE
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State | MI
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Zip | 49418-2097
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Country | US
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Telephone | 616-483-0335
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Fax |
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Provider Business Mailing Address
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Address Line | 6111 SUMMERHILL CT
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City | HUDSONVILLE
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State | MI
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Zip | 49426-8913
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Country | US
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Telephone | 616-483-0335
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANET STARK
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Credential | LLMSW
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Telephone | 616-483-0335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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