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General NPI Number Information
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NPI Number | 1851642367
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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 | 09/24/2012
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Last Update Date | 09/24/2012
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Provider Practice Location Address
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Address Line | 1823 COMMERCE ST 2333 JARMAN ST
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City | MUSKEGON
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State | MI
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Zip | 49441
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Country | US
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Telephone | 231-728-2138
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Fax | 231-722-4771
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Provider Business Mailing Address
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Address Line | 1823 COMMERCE ST SAME
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City | MUSKEGON
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State | MI
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Zip | 49441
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Country | US
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Telephone | 231-728-2138
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Fax | 231-722-4771
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Authorized Official
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Title or Position | CERTIFIED ALCOHOL & DRUG COUNSELO
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Name | RANDAL EUGENE DAME
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Credential | ASSOCIATES CADC-M
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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