Provider Demographics
NPI:1114635505
Name:CRYSTAL MEEUSEN, LLC
Entity Type:Organization
Organization Name:CRYSTAL MEEUSEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-635-7425
Mailing Address - Street 1:246 CENTER GREEN MEADOW ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6827
Mailing Address - Country:US
Mailing Address - Phone:616-635-7425
Mailing Address - Fax:
Practice Address - Street 1:O-745 LAKE MICHIGAN DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-6795
Practice Address - Country:US
Practice Address - Phone:616-202-6527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health