Provider Demographics
NPI:1790799542
Name:NORTH KENT GUIDANCE SERVICES LLC
Entity Type:Organization
Organization Name:NORTH KENT GUIDANCE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKILLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-361-5001
Mailing Address - Street 1:5250 NORTHLAND DRIVE SUITE A
Mailing Address - Street 2:NORTH KENT GUIDANCE SERVICES LLC
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1040
Mailing Address - Country:US
Mailing Address - Phone:616-361-5001
Mailing Address - Fax:616-361-2166
Practice Address - Street 1:106 S GREENVILLE WEST DRIVE
Practice Address - Street 2:NORTH KENT GUIDANCE SERVICES
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838
Practice Address - Country:US
Practice Address - Phone:616-754-2364
Practice Address - Fax:616-361-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N83600Medicare ID - Type Unspecified