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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 ADMINISTRATOR)
(616) 281-6372
Entity
Organization
Contact information
Practice address
9090 S RODGERS CT SE, CALEDONIA, MI 49316-8052
(616) 891-8770
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5460
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
MI
103T00000X
Psychologist
—
MI
104100000X
Social Worker
Primary
—
MI
2084P0800X
Psychiatry Physician
—
MI
283Q00000X
Psychiatric Hospital
—
—
363A00000X
Physician Assistant
—
MI
363L00000X
Nurse Practitioner
—
MI
Other
Enumeration date
11/18/2015
Last updated
11/04/2020
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