Provider Demographics
NPI:1316615057
Name:ROCK YOUR MIND THERAPY PLLC
Entity type:Organization
Organization Name:ROCK YOUR MIND THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-638-4078
Mailing Address - Street 1:987 S SANDALWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5998
Mailing Address - Country:US
Mailing Address - Phone:616-638-4078
Mailing Address - Fax:
Practice Address - Street 1:4441 GRAND HAVEN RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5507
Practice Address - Country:US
Practice Address - Phone:616-855-7625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1902391733OtherNPI