| Organization Name: | PINE REST CHRISTIAN MENTAL HEALTH SERVICES |
| NPI Number: | 1427216241 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DOUGLAS P VANCE (VICE PRESIDENT OF GENERAL SERVICES) |
| Mailing Address: | 4294 Laurel Dr Lake Odessa |
| State: | MI US |
| Postal Code: | 488499423 |
| Phone Number: | 6168918770 |
| Fax Number: | |
| NPI Enumeration Date: | 05/29/2008 |
| NPI Last Update Date: | 05/29/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |