Organization · Type 2 NPI

Cherry Street Services Inc

Federally Qualified Health Center (FQHC) · Grand Rapids, MI

NPI number 1043592629 Active

Practice location

1400 Leonard Street NE
Grand Rapids, MI 49505-5515

Call (616) 954-1991 Map

Fax (616) 954-1998

Mailing address

100 Cherry St SE
Grand Rapids, MI 49503-4748

Specialties and licenses

Taxonomy	Code	License
Clinical Neuropsychologist	103G00000X	None listed
Counseling Psychologist	103TC1900X	None listed
Clinical Social Worker	1041C0700X	None listed
Family Medicine Physician	207Q00000X	None listed
Internal Medicine Physician	207R00000X	None listed
Pediatric Adolescent Medicine Physician	2080A0000X	None listed
Federally Qualified Health Center (FQHC) Primary	261QF0400X	None listed
Mobile Radiology Clinic/Center	261QR0208X	None listed

Federally Qualified Health Center (FQHC): Definition to come...

Another provider at this address

Life Guidance ServiesClinical Social Worker Grand Rapids, MI NPI 1942510425

Other federally qualified health center (fqhc) providers in Grand Rapids

See all in Grand Rapids →

NPI record

NPI: 1043592629
Entity type: Organization (Type 2)
Issued: Sep 9, 2011
Last updated: Oct 1, 2021
Status: Active
Subpart: Yes of Cherry Street Services Inc

Other names

<unavail>
Leonard Street Counseling Center · doing business as
Leonard Street Counseling Center · doing business as

Authorized official

Mr. Tasha Blackmon
Executive Director
(616) 776-2121

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

Is this your record? How to update it.

About NPI 1043592629

Cherry Street Services Inc's National Provider Identifier is 1043592629, issued on Sep 9, 2011. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Grand Rapids, MI. The record was last updated on Oct 1, 2021.