Provider Demographics
NPI:1912601618
Name:PRUDENTIA COUNSELING AND CONSULTING, LLC
Entity type:Organization
Organization Name:PRUDENTIA COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MENEREY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW-CAADC
Authorized Official - Phone:616-446-6718
Mailing Address - Street 1:437 MULFORD DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3568
Mailing Address - Country:US
Mailing Address - Phone:616-446-6718
Mailing Address - Fax:
Practice Address - Street 1:2025 E BELTLINE AVE SE STE 102
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7673
Practice Address - Country:US
Practice Address - Phone:616-446-6718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty