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General NPI Number Information
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NPI Number | 1639894405
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Entity Type | Organization
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Legal Business Name | MINDFUL HEALTH ADOLESCENT & ADULT COUNSELING, LLC
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Dates
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Enumeration Date | 10/05/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 3339 CRYSTAL RIVER ST SW
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City | WYOMING
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State | MI
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Zip | 49418
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Country | US
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Telephone | 616-498-6484
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Fax |
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Provider Business Mailing Address
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Address Line | 250 MONROE AVE NW STE 400
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2293
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Country | US
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Telephone | 616-498-6484
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Fax |
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Authorized Official
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Title or Position | BILLING & CREDENTIALING
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Name | STEPHANIE JONES
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Credential |
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Telephone | 810-422-5474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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