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Organization

PINE REST CHRISTIAN MENTAL HEALTH SERVICES

Active
Other names
Pine Rest Community Services Substance Abuse
Organization subpart
No

Provider details

NPI number
Authorized official
DIANE M FENNEMA (MANAGED CARE ADMINISTRATOR)
(616) 281-6372
Entity
Organization

Contact information

Practice address
320 COMMERCE AVE SW, GRAND RAPIDS, MI 49503-4101
(616) 258-7599
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 281-6372

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
103T00000X
Psychologist
103TC0700X
Clinical Psychologist
1041C0700X
Clinical Social Worker
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
2084P0800X
Psychiatry Physician
283Q00000X
Psychiatric Hospital
Primary
324500000X
Substance Abuse Rehabilitation Facility
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Enumeration date
11/09/2021
Last updated
03/11/2022
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