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Organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Active
Organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE FENNEMA (MANAGED CARE ADMINISTATOR)
(616) 281-6372
Entity
Organization
Contact information
Practice address
1870 LEONARD ST NE, GRAND RAPIDS, MI 49505-5650
(616) 956-9619
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5270
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
MI
103T00000X
Psychologist
—
MI
104100000X
Social Worker
—
MI
2084P0800X
Psychiatry Physician
—
MI
363A00000X
Physician Assistant
Primary
—
MI
363L00000X
Nurse Practitioner
—
MI
Other
Enumeration date
11/09/2015
Last updated
11/04/2020
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