| NPI | 1568040368 |
|---|---|
| Other Name | PINE REST TELEHEALTH CLINIC |
| Entity Type | Organization |
| Authorized Contact | DIANE M FENNEMA Managed Care Administrator 616-281-6372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist, Clinical | |
| 1041C0700X Social Worker, Clinical | |
| 208000000X Pediatrics | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry | |
| 208D00000X General Practice | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2022-03-11 |