Pine Rest Telehealth Clinic

LBN: Pine Rest Christian Mental Health Services
Pine Rest Telehealth Clinic is an health care organization with primary practice located at 300 68Th St Se , Grand Rapids MI 49548-6927. The organization recently has 12 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Social Worker, Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Addiction Psychiatry, Allopathic & Osteopathic Physicians / General Practice, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Behavioral Health & Social Service Providers / Social Worker is the primary health care specialty. Pine Rest Christian Mental Health Services can be contacted via phone (616) 281-6372, or through Fennema, Diane M via phone (616) 281-6372.

Contact Information

Primary practice address
300 68Th St Se Grand Rapids MI 49548-6927
Phone: (616) 281-6372
Fax: (616) 281-6459
Website:
Map and Directions
Authorized official contact:
Name: Fennema, Diane M
Phone: (616) 281-6372

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Professional 101YP2500X
Behavioral Health & Social Service Providers / Psychologist 103T00000X
Behavioral Health & Social Service Providers / Clinical 103TC0700X
Behavioral Health & Social Service Providers / Social Worker 104100000X
Behavioral Health & Social Service Providers / Clinical 1041C0700X
Allopathic & Osteopathic Physicians / Pediatrics 208000000X
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X
Allopathic & Osteopathic Physicians / Addiction Psychiatry 2084P0802X
Allopathic & Osteopathic Physicians / General Practice 208D00000X
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X

Profile Details

NPI number 1568040368
LBN Legal business name Pine Rest Christian Mental Health Services
DBA Doing business as Pine Rest Telehealth Clinic
Authorized official Fennema, Diane M
Entity Organization
Organization subpart 1 No
Enumeration date Apr 1st, 2021
Last updated Mar 11th, 2022 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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