MEDICARE: THE TRAUMA AND ATTACHMENT CENTER OF WEST MICHIGAN

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	:	1306544358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE TRAUMA AND ATTACHMENT CENTER OF WEST MICHIGAN

Provider Business Mailing Address
First Line	:	12330 JAMES ST STE A80
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-8581
Country	:	US
Telephone Number	:	616-757-5667
Fax Number	:

Provider Business Practice Location Address
First Line	:	12330 JAMES ST STE A80
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-8581
Country	:	US
Telephone Number	:	616-757-5667
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	DANIELLE DURON
Credential	:	MA, LPC
Telephone Number	:	616-757-5667

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	04/14/2023

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Directions to “THE TRAUMA AND ATTACHMENT CENTER OF WEST MICHIGAN ” Practice Location

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