| Mind Body Soulutions, Llc | |
|
5242 Plainfield Ave Ne Grand Rapids MI 49525-1084 | |
| (616) 613-6130 | |
| Not Available |
| Full Name | Mind Body Soulutions, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5242 Plainfield Ave Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Anyssa Grendel (LICENSED MASTERS SOCIAL WORKER) |
| Authorized Official Contact | 6162404685 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind Body Soulutions, Llc 5242 Plainfield Ave Ne Grand Rapids MI 49525-1084 Ph: (616) 613-6130 | Mind Body Soulutions, Llc 5242 Plainfield Ave Ne Grand Rapids MI 49525-1084 Ph: (616) 613-6130 |
| NPI Number | 1609327808 |
|---|---|
| Provider Enumeration Date | 10/22/2016 |
| Last Update Date | 03/07/2024 |
| Certification Date | 03/07/2024 |
| Medicare PECOS PAC ID | 0143643650 |
|---|---|
| Medicare Enrollment ID | O20200630002901 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609327808 | NPI | - | NPPES |
| 1598157612 | Other | TYPE 1 INDIVIDUAL NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801096853 (Michigan) | Primary |
| Provider Name | Anyssa L Grendel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598157612 PECOS PAC ID: 1658690540 Enrollment ID: I20150427001251 |
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