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General NPI Number Information
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NPI Number | 1831397660
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Entity Type | Organization
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Legal Business Name | LIFEFOCUS MENTAL HEALTH
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2525 E PARIS AVE SE SUITE 111
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6191
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Country | US
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Telephone | 616-451-2777
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Fax | 616-451-3888
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Provider Business Mailing Address
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Address Line | 2525 E PARIS AVE SE SUITE 111
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6191
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Country | US
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Telephone | 616-451-2777
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Fax | 616-451-3888
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. CHERYL M SOARD
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Credential | LMSW
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Telephone | 616-451-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 410311
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License Number State | MI
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