MEDICARE: VIRTUWELL THERAPY, 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1871356212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRTUWELL THERAPY, LLC

Provider Business Mailing Address
First Line	:	333 BRIDGE ST NW STE 1120
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-5356
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 BRIDGE ST NW STE 1120
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-5356
Country	:	US
Telephone Number	:	616-805-3660
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER AND CEO
Name	:	SARAH ELIZABETH TIMMER
Credential	:
Telephone Number	:	616-805-3660

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	02/05/2024

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