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30 Jefferson Ave Se Grand Rapids MI 49503-4304 | |
| (616) 303-1313 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 30 Jefferson Ave Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Peter Cappon (OWNER) |
| Authorized Official Contact | 6162028240 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3413 Tomahawk Dr Sw Grandville MI 49418-1961 Ph: (616) 303-1313 | 30 Jefferson Ave Se Grand Rapids MI 49503-4304 Ph: (616) 303-1313 |
| NPI Number | 1457962078 |
|---|---|
| Provider Enumeration Date | 08/17/2020 |
| Last Update Date | 10/11/2024 |
| Certification Date | 10/11/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457962078 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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