Doctor Name: | MR. SHAWN A. BULTSMA |
NPI Number: | 1225112493 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.ED., L.L.P.C. |
License Number: | L964762 |
Business Practice Address: | 1514 Wealthy St Se Suite 260 Grand Rapids, MI - 495062755 |
Business Phone Number: | 6167454637 |
Business Fax Number: | |
Mailing Address: | 327 Carlton Ave Se, GRAND RAPIDS |
State: | MI |
Postal Code: | 495061609 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/24/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | L964762 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |