| NPI | 1427216241 |
|---|---|
| Doing Business As | PINE REST LAKE ODESSA OFFICE |
| Entity Type | Organization |
| Authorized Contact | DIANE P FENNEMA Managed Care Administrator 616-281-6372 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 283Q00000X Psychiatric Hospital | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2020-11-04 |