Provider Demographics
NPI:1972067189
Name:MARTHA VELTING THERAPY
Entity Type:Organization
Organization Name:MARTHA VELTING THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:CAROLE SORENSON
Authorized Official - Last Name:VELTING
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-460-9544
Mailing Address - Street 1:363 BALL PARK BLVD NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4908
Mailing Address - Country:US
Mailing Address - Phone:616-460-9544
Mailing Address - Fax:
Practice Address - Street 1:233 FULTON ST E STE 524
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3200
Practice Address - Country:US
Practice Address - Phone:616-460-9544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty