Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | MI | |
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor | 6401016108 | MI |
NPI | 1144759655 |
---|---|
Provider Name | Mr. Kimber Glenn Decker |
First Address | Grand Rapids, MI 49503-3422 |
Second Address | Grand Rapids, MI 49503-3422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2017 |
Last Update Date | 16/06/2018 |