| NPI | 1215407044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE ROBERTS Owner 616-460-0174 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC1900X Psychologist Counseling | |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2020-11-27 |