Organization
CHERRY STREET SERVICES INC
Active
Parent organization
CHERRY STREET SERVICES
Other names
Wyoming Community Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHERRY STREET SERVICES
Authorized official
MRS. TASHA BLACKMON (CEO)
(616) 965-8200
Entity
Organization
Contact information
Practice address
2929 BURLINGAME AVE SW, WYOMING, MI 49509-2609
(616) 965-8333
(616) 940-5820
Mailing address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
104100000X
Social Worker
—
—
122300000X
Dentist
—
—
133V00000X
Registered Dietitian
—
—
152W00000X
Optometrist
—
—
156FX1800X
Optician
—
—
163W00000X
Registered Nurse
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
09/14/2012
Last updated
05/17/2024
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