NPI 1043592629 · live from the CMS NPI Registry
Cherry Street Services INC
Clinic/Center, Federally Qualified Health Center (FQHC) in Grand Rapids, MI. National Provider Identifier 1043592629, active.
NPI record
| NPI | 1043592629 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Clinic/Center, Federally Qualified Health Center (FQHC) 261QF0400X |
| Practice location | 1400 Leonard Street Ne, Grand Rapids, MI 49505 |
| Practice phone | 616-954-1991 |
| Mailing address | 100 Cherry St Se, Grand Rapids, MI 49503 |
| Enumerated | September 9, 2011 |
| Last updated | October 1, 2021 |
| Authorized official | Tasha Blackmon, Executive Director |
| Other names | Leonard Street Counseling Center |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinical Neuropsychologist | 103G00000X | — |
| Family Medicine | 207Q00000X | — |
| Internal Medicine | 207R00000X | — |
| Pediatrics, Adolescent Medicine | 2080A0000X | — |
| Psychologist, Counseling | 103TC1900X | — |
| Social Worker, Clinical | 1041C0700X | — |
| Clinic/Center, Radiology, Mobile | 261QR0208X | — |
| Clinic/Center, Federally Qualified Health Center (FQHC) primary | 261QF0400X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.