MEDICARE: JUSTINE TER HAAR

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	1041C0700X	Clinical Social Worker	6801087775	MI

General Provider Information

NPI Number	:	1447635123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE TER HAAR

Provider Business Mailing Address
First Line	:	1684 64TH AVE
Second Line	:
City	:	ZEELAND
State	:	MI
Zip	:	49464-9308
Country	:	US
Telephone Number	:	616-403-2094
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 S BEACON BLVD STE 200
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2588
Country	:	US
Telephone Number	:	616-846-2015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2015
Last Update Date	:	07/23/2015

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Directions to “ JUSTINE TER HAAR ” Practice Location

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