Organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Active
Parent organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Authorized official
DIANE G FENNEMA (MANAGED CARE ADMINISTRATOR)
(616) 281-6372
Entity
Organization
Contact information
Practice address
17325 VAN WAGONER RD, SPRING LAKE, MI 49456-9702
(616) 847-5145
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
—
—
104100000X
Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
283Q00000X
Psychiatric Hospital
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
12/26/2014
Last updated
11/04/2020
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