Provider Demographics
NPI:1982956231
Name:ZOMERLEI, DANIEL RYAN (PHD, MDIV, LMFT)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RYAN
Last Name:ZOMERLEI
Suffix:
Gender:M
Credentials:PHD, MDIV, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 CANAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2667
Mailing Address - Country:US
Mailing Address - Phone:616-222-0631
Mailing Address - Fax:616-222-0631
Practice Address - Street 1:4301 CANAL AVE SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2667
Practice Address - Country:US
Practice Address - Phone:616-222-0631
Practice Address - Fax:616-222-0631
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006532106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist