| Behavioral Health Services, Rehab, Healthcare Provider, Counseling | |
|
924 Eastern Ave Se Grand Rapids MI 49507-1303 | |
| (231) 343-2753 | |
| Not Available |
| Full Name | Behavioral Health Services, Rehab, Healthcare Provider, Counseling |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 924 Eastern Ave Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Pam M Duvall-bateman (CEO) |
| Authorized Official Contact | 6162723796 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Behavioral Health Services, Rehab, Healthcare Provider, Counseling 349 Jackson Ave Muskegon MI 49442-1114 Ph: (231) 343-2753 | Behavioral Health Services, Rehab, Healthcare Provider, Counseling 924 Eastern Ave Se Grand Rapids MI 49507-1303 Ph: (231) 343-2753 |
| NPI Number | 1376866160 |
|---|---|
| Provider Enumeration Date | 03/08/2010 |
| Last Update Date | 10/24/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376866160 | NPI | - | NPPES |
| 1376866160 | Other | MI | SUBPART HEALTHCARE PROVIDER LICENSE: 410357, 610081, 700099, 110106 |
| 1376866160 | Medicaid | MI |
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