Provider Demographics
NPI:1568022465
Name:YENSCH, GRACE (MA, TLLP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:YENSCH
Suffix:
Gender:F
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 NORTHLAND DR NE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1096
Mailing Address - Country:US
Mailing Address - Phone:616-361-5001
Mailing Address - Fax:
Practice Address - Street 1:1145 W RANDALL ST STE 2A
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-1393
Practice Address - Country:US
Practice Address - Phone:616-361-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017899103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling