| NPI | 1619341310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE FENNEMA Managed Care Administrator 616-281-6372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103T00000X Psychologist | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 283Q00000X Psychiatric Hospital | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2020-11-04 |