Provider Demographics
NPI:1205952843
Name:PLAINFIELD COMMUNITY COUNSELING
Entity type:Organization
Organization Name:PLAINFIELD COMMUNITY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:ALLERS
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:616-361-3365
Mailing Address - Street 1:5181 PLAINFIELD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1086
Mailing Address - Country:US
Mailing Address - Phone:616-361-3365
Mailing Address - Fax:616-361-3395
Practice Address - Street 1:5181 PLAINFIELD NE
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1086
Practice Address - Country:US
Practice Address - Phone:616-361-3365
Practice Address - Fax:616-361-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003194103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty