1376235614 NPI number — EMILY L. BERRY, BEHAVIORAL CONSULTANTS

Table of content: DR. IRIS ZORAIDA ZAVALA PH.D. (NPI 1457562563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376235614 NPI number — EMILY L. BERRY, BEHAVIORAL CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMILY L. BERRY, BEHAVIORAL CONSULTANTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376235614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1818 HILLCREST STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND HAVEN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-403-1724
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 W. SAVIDGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND HAVEN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-209-8288
Provider Business Practice Location Address Fax Number:
313-569-5969
Provider Enumeration Date:
05/24/2023

Additional Information

Authorized Official

Authorized Official Last Name:
BERRY
Authorized Official First Name:
EMILY
Authorized Official Middle Name:
LAWSON
Authorized Official Title or Position:
MANAGER/OWNER/THERAPIST
Authorized Official Telephone Number:
616-403-1724

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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