Provider Demographics
NPI:1851642367
Name:WEST MICHIGAN THERAPY INC
Entity Type:Organization
Organization Name:WEST MICHIGAN THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ALCOHOL & DRUG COUNSELO
Authorized Official - Prefix:
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:DAME
Authorized Official - Suffix:
Authorized Official - Credentials:ASSOCIATES CADC-M
Authorized Official - Phone:231-728-2138
Mailing Address - Street 1:1823 COMMERCE ST
Mailing Address - Street 2:SAME
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441
Mailing Address - Country:US
Mailing Address - Phone:231-728-2138
Mailing Address - Fax:231-722-4771
Practice Address - Street 1:1823 COMMERCE ST
Practice Address - Street 2:2333 JARMAN ST
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441
Practice Address - Country:US
Practice Address - Phone:231-728-2138
Practice Address - Fax:231-722-4771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health