# PINE REST CHRISTIAN MENTAL HEALTH SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PINE REST CHRISTIAN MENTAL HEALTH SERVICES
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1679777049
- **Legal business name:** PINE REST CHRISTIAN MENTAL HEALTH SERVICES
- **Authorized official:** DIANE M FENNEMA (MANAGED CARE ADMINISTRATOR)
- **Authorized official phone:** (616) 281-6372

## Contact information

- **Practice address:** 243 68TH ST SE, GRAND RAPIDS, MI 49548-6924
- **Practice address phone:** (616) 281-6836
- **Mailing address:** 300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
- **Mailing address phone:** (616) 455-5000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 103K00000X | Behavior Analyst | — | NULL | — |
| 103K00000X | Behavior Analyst | — | — | — |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 104100000X | Social Worker | — | NULL | — |
| 104100000X | Social Worker | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |
| 324500000X | Substance Abuse Rehabilitation Facility | 410334 | MI | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 06/12/2007
- **Last updated:** 06/18/2026