Provider Demographics
NPI:1073196028
Name:SPOELMA, DAVID LEE
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:SPOELMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N CALVIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1928
Mailing Address - Country:US
Mailing Address - Phone:810-417-6281
Mailing Address - Fax:
Practice Address - Street 1:387 W LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1912
Practice Address - Country:US
Practice Address - Phone:810-417-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional