Provider Demographics
NPI:1285765214
Name:CHRIST LIFE COUNSELING CENTER OF GRAND RAPIDS
Entity type:Organization
Organization Name:CHRIST LIFE COUNSELING CENTER OF GRAND RAPIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SPRATT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-365-8074
Mailing Address - Street 1:2899 W 136TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327-8804
Mailing Address - Country:US
Mailing Address - Phone:616-365-8074
Mailing Address - Fax:
Practice Address - Street 1:150 ANN ST NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-6244
Practice Address - Country:US
Practice Address - Phone:616-365-8074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health