Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Pine Rest Christian Mental Heatth Services

Organization Psychologist · NPI 1508875667

Pine Rest Christian Mental Heatth Services is a Psychologist in Grand Rapids, Michigan. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
5

Practice location Address checks out

310 Lafayette Ave SE
Grand Rapids, MI 49503-4693
Phone: (616) 913-1400
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X
Psychologist Taxonomy 103T00000X
Social Worker Taxonomy 104100000X
Physician Assistant Taxonomy 363A00000X
Nurse Practitioner Taxonomy 363L00000X

Record details

NPI number1508875667
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationPine Rest Christian Mental Health Services
Authorized official Diane Fennema — Managed Care Administrator · (616) 281-6372
NPI enumeratedAugust 7, 2006
Last updated in NPPESNovember 4, 2020
Certification dateNovember 4, 2020
Mailing address300 68th St Se, Grand Rapids, MI 49548-6927

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