=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578966743
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VANDENBOSCH COUNSELING SERVICES PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2014
-----------------------------------------------------
Last Update Date | 10/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 WASHINGTON AVE STE 380
-----------------------------------------------------
City | GRAND HAVEN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49417-3318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-670-7631
-----------------------------------------------------
Fax | 616-607-2006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41 WASHINGTON AVE STE 380
-----------------------------------------------------
City | GRAND HAVEN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49417-3318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-670-7631
-----------------------------------------------------
Fax | 616-607-2006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL BILLER
-----------------------------------------------------
Name | BRENDA SNELLENBERGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 616-935-0747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6801093484
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------