Basic Information
| Provider Information | |||||||||
| NPI: | 1770726663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALMISH | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | L.L.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 VAN RAALTE DR SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495091100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166481566 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3300 36TH ST SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495122810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169422110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2009 | ||||||||
| LastUpdateDate: | 04/08/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401011292 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.