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General NPI Number Information
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NPI Number | 1588429732
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Entity Type | Organization
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Legal Business Name | GRAND RAPIDS SOMATIC THERAPY LLC
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 5242 PLAINFIELD AVE NE STE C
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1084
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Country | US
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Telephone | 616-915-1578
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 N HAMPTON DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-5931
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMILY WARNING
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Credential | LMSW
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Telephone | 616-915-1578
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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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