Provider Demographics
NPI:1275998049
Name:HOLISTIC COUNSELING SERVICES
Entity Type:Organization
Organization Name:HOLISTIC COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-862-3296
Mailing Address - Street 1:2524 WOODMEADOW DR SE
Mailing Address - Street 2:STE. 1
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8051
Mailing Address - Country:US
Mailing Address - Phone:616-862-3296
Mailing Address - Fax:616-466-7944
Practice Address - Street 1:2524 WOODMEADOW DR SE
Practice Address - Street 2:STE. 1
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8051
Practice Address - Country:US
Practice Address - Phone:616-862-3296
Practice Address - Fax:616-466-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010823381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6092Medicaid