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General NPI Number Information
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NPI Number | 1699981498
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Entity Type | Organization
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Legal Business Name | WEST MICHIGAN THERAPY INC
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 130 E APPLE AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-3405
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Country | US
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Telephone | 231-728-2138
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Fax |
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Provider Business Mailing Address
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Address Line | 130 E APPLE AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-3405
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Country | US
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Telephone | 231-728-2138
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. LOUIS CHURCHWELL
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Credential | BS, CACII, ICA, C-2
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Telephone | 231-728-2138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 610050
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 610022
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License Number State | MI
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