Individual
TRISTEN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3940 PENINSULAR DR SE STE 230A404, GRAND RAPIDS, MI 49546-2442
(616) 315-1226
Mailing address
5030 CORPORATE EXCHANGE BLVD SE FL 2, GRAND RAPIDS, MI 49512-5506
(616) 315-1226
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
178018115
IL
101YM0800X
Mental Health Counselor
Primary
6401224084
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
994069486
IRS
MI
05
—
994069486
—
MI
05
—
994981279
—
MI
Enumeration date
05/08/2014
Last updated
10/17/2024
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