Organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN LARUE (VP CONTRACTING)
(616) 281-6373
Entity
Organization
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5270
(616) 281-6459
Mailing address
300 68TH ST SE, PO BOX 165, GRAND RAPIDS, MI 49548-6927
(616) 281-6372
(616) 281-6459
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
207L00000X
Anesthesiology Physician
—
—
207R00000X
Internal Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
283Q00000X
Psychiatric Hospital
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00290
BC/BS
MI
05
—
1556812
—
MI
Enumeration date
03/09/2006
Last updated
11/11/2025
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