MEDICARE: JOSHUA NIEUWSMA LLPC

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	6401012528	MI

General Provider Information

NPI Number	:	1487046546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA NIEUWSMA LLPC

Provider Business Mailing Address
First Line	:	805 LEONARD ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-1138
Country	:	US
Telephone Number	:	616-916-9477
Fax Number	:	616-361-4141

Provider Business Practice Location Address
First Line	:	2944 FULLER AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-3784
Country	:	US
Telephone Number	:	616-916-9477
Fax Number	:

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

Provider Enumeration Date	:	02/26/2015
Last Update Date	:	02/26/2015

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