MEDICARE: BIRCHWOOD COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1053959668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRCHWOOD COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	1444 MICHIGAN ST NE STE 7
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2028
Country	:	US
Telephone Number	:	248-894-8421
Fax Number	:

Provider Business Practice Location Address
First Line	:	1444 MICHIGAN ST NE STE 7
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2028
Country	:	US
Telephone Number	:	248-894-8421
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ASHLEY JANSMA
Credential	:	LPC
Telephone Number	:	248-894-8421

Provider Enumeration Date	:	12/13/2019
Last Update Date	:	12/13/2019

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