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General NPI Number Information
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NPI Number | 1689134074
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Entity Type | Organization
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Legal Business Name | PORTAL POINT COUNSELING, LLC
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 03/21/2019
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Provider Practice Location Address
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Address Line | 2663 44TH ST SW STE 106
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City | WYOMING
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State | MI
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Zip | 49519-4189
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Country | US
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Telephone | 616-299-8789
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Fax |
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Provider Business Mailing Address
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Address Line | 2178 BYRON SHORES DR SW
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City | BYRON CENTER
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State | MI
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Zip | 49315-8087
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Country | US
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Telephone | 616-299-8787
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. RACHEL MARIE VANBUSKIRK
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Credential | LMSW
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Telephone | 616-299-8789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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