Provider Demographics
NPI:1932569407
Name:RIETVELD, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:RIETVELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 136TH AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1897
Mailing Address - Country:US
Mailing Address - Phone:616-393-2188
Mailing Address - Fax:616-393-2182
Practice Address - Street 1:665 136TH AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1897
Practice Address - Country:US
Practice Address - Phone:616-393-2188
Practice Address - Fax:616-393-2182
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI740101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)