Individual
JEREMEY ALAN WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLPC
Contact information
Practice address
41 WASHINGTON AVE STE 368, GRAND HAVEN, MI 49417-1378
(616) 844-3387
Mailing address
12585 CANTERBURY CT, GRAND HAVEN, MI 49417-8353
(616) 844-3387
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
640109402
MI
Other
Enumeration date
06/08/2021
Last updated
06/08/2021
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