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Organization
NTL ADULT FOSTER CARE
Active
Organization
NTL ADULT FOSTER CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNIE R TYLER (OWNER)
(616) 375-9786
Entity
Organization
Contact information
Practice address
1056 BATES ST SE, GRAND RAPIDS, MI 49506-2681
(616) 647-5945
Mailing address
1056 BATES ST SE, GRAND RAPIDS, MI 49506-2681
(616) 647-5945
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
Primary
—
NULL
103TA0700X
Adult Development & Aging Psychologist
Primary
—
—
Other
Enumeration date
11/16/2017
Last updated
11/16/2017
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