Provider Demographics
NPI:1336711480
Name:OSTRANDER, ISRAEL URIAS LEE (TLLP)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:URIAS LEE
Last Name:OSTRANDER
Suffix:
Gender:M
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 GEORGE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1409
Mailing Address - Country:US
Mailing Address - Phone:231-408-0526
Mailing Address - Fax:
Practice Address - Street 1:6810 OLD 28TH ST SE STE 4
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6932
Practice Address - Country:US
Practice Address - Phone:616-264-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009314103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling