Organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Active
Parent organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Authorized official
DIANE FENNEMA (MANAGED CARE ADMINISTATOR)
(616) 281-6372
Entity
Organization
Contact information
Practice address
1050 SILVER DR, TRAVERSE CITY, MI 49684-5749
(231) 947-2255
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
1041S0200X
School Social Worker
—
—
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
283Q00000X
Psychiatric Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110D148370
INTERNAL MEDICINE
MI
01
—
260D17625
BCBS PSYCHIATRIST
MI
01
—
350D148360
PEDIATRICS
MI
01
—
500D11133
NURSE PRACTIONERS
MI
01
—
680D16189
PSYCHOLOGISTS
MI
01
—
800D16222
SOCIAL WORKERS
MI
01
—
P10D11275
PSYCHOLOGISTS-DOCTORAL LL
MI
01
—
PSYCHIATIRSTS
MULTISPECIALTY
MI
Enumeration date
01/18/2007
Last updated
11/04/2020
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