Organization
TOUCHSTONE INNOVARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM VANDER LUGT (V.P. FINANCE)
(616) 459-4212
Entity
Organization
Contact information
Practice address
201 SHELDON BLVD SE, GRAND RAPIDS, MI 49503-4513
(616) 459-4212
(616) 774-9022
Mailing address
201 SHELDON BLVD SE, GRAND RAPIDS, MI 49503-4513
(616) 459-4212
(616) 774-9022
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260D16159
BLUE CROSS GROUP NUMBER
MI
Enumeration date
11/15/2006
Last updated
09/11/2025
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