| NPI | 1417355322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELITA TRAVIS JOHNSON Therapist Consultant 616-481-9337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MI 6801063274) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-09 |