Provider Demographics
NPI:1659147551
Name:HEALING CENTER OF WEST MICHIGAN PLLC
Entity type:Organization
Organization Name:HEALING CENTER OF WEST MICHIGAN PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HULTINK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-796-4335
Mailing Address - Street 1:1345 MONROE AVE NW STE 332
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-4673
Mailing Address - Country:US
Mailing Address - Phone:616-796-4335
Mailing Address - Fax:616-381-4089
Practice Address - Street 1:1345 MONROE AVE NW STE 332
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4673
Practice Address - Country:US
Practice Address - Phone:616-796-4335
Practice Address - Fax:616-381-4089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty