| NPI | 1154339521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE FENNEMA Managed Care Administrator 616-281-6372 |
| Organization Subpart ? | |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 103T00000X Psychologist |
| 104100000X Social Worker | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-11-04 |