Organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE FENNEMA (MANAGED CARE ADMINISTRATOR)
(616) 281-6372
Entity
Organization
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 281-6372
(616) 281-6459
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 281-6372
(616) 281-6459
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
MI
Other
Enumeration date
10/13/2015
Last updated
11/04/2020
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