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832 Forest Hill Ave Se Grand Rapids MI 49546-2326 | |
| (616) 940-9001 | |
| (616) 940-7355 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 832 Forest Hill Ave Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Elbin Alfredo Orellana (PRESIDENT) |
| Authorized Official Contact | 6169409001 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
832 Forest Hill Ave Se Grand Rapids MI 49546-2326 Ph: (616) 940-9001 | 832 Forest Hill Ave Se Grand Rapids MI 49546-2326 Ph: (616) 940-9001 |
| NPI Number | 1922120955 |
|---|---|
| Provider Enumeration Date | 04/03/2007 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922120955 | NPI | - | NPPES |
| 101761232 | Medicaid | MI | |
| 260D110460 | Other | MI | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | EO045303 (Michigan) | Primary |
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