| NPI | 1194215558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND HERZOG Owner Operator 616-901-2784 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301011394) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2018-05-11 |