Basic Information
| Provider Information | |||||||||
| NPI: | 1205935228 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CURTIS | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MA LPC LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 68TH ST SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495486927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164555000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4211 PARKWAY PL SW | ||||||||
| Address2: | |||||||||
| City: | GRANDVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494182695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162223700 | ||||||||
| FaxNumber: | 6162223707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 12/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401008196 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 4101006232 | MI | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.