Provider Demographics
NPI:1770192429
Name:SERRANO, NELSON
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NELSON
Other - Middle Name:
Other - Last Name:SERRANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PEER RECOVERY COACH
Mailing Address - Street 1:370 COUNTRY CLUB RD STE A
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-8303
Mailing Address - Country:US
Mailing Address - Phone:616-393-2188
Mailing Address - Fax:616-393-2182
Practice Address - Street 1:370 COUNTRY CLUB RD STE A
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-8303
Practice Address - Country:US
Practice Address - Phone:616-393-2188
Practice Address - Fax:616-393-2182
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIS650626012599175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist