MEDICARE: AMY ZEILSTRA COUNSELING

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1588412134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY ZEILSTRA COUNSELING

Provider Business Mailing Address
First Line	:	266 AURORA ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3124
Country	:	US
Telephone Number	:	616-970-1138
Fax Number	:

Provider Business Practice Location Address
First Line	:	734 ALGER ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3593
Country	:	US
Telephone Number	:	616-970-1138
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	AMY LYNN ZEILSTRA
Credential	:	LMSW
Telephone Number	:	616-970-1138

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	05/08/2024

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