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 (VP OF GENERAL SERVICES)
(616) 281-6372
Entity
Organization
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110D148370
INTERNAL MD
MI
01
—
260D17625
PSYCHIATRISTS
MI
01
—
350D148360
PEDIATRICS
MI
01
—
500D11133
NURSE PRACTICIONERS
MI
01
—
680D16189
PSYCHOLOGISTS
MI
01
—
70D16083
MULTISPECIALTY
MI
01
—
P10D11275
PSYCHOLOGISTS-MA, DOCTORA
MI
Enumeration date
08/07/2006
Last updated
11/04/2020
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