Provider Demographics
NPI:1104663772
Name:FAN0SAARELA LLC
Entity type:Organization
Organization Name:FAN0SAARELA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAARELA
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:616-886-7076
Mailing Address - Street 1:229 WESTOWN DR NW APT 201
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-3697
Mailing Address - Country:US
Mailing Address - Phone:616-886-7076
Mailing Address - Fax:
Practice Address - Street 1:2450 44TH ST SE STE 302
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-9081
Practice Address - Country:US
Practice Address - Phone:616-886-7076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty