Provider Demographics
NPI:1366064065
Name:SUNBURST INTEGRATIVE THERAPY & WELLNESS PLLC
Entity type:Organization
Organization Name:SUNBURST INTEGRATIVE THERAPY & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KIRSTEN
Authorized Official - Last Name:PARKS-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-560-5475
Mailing Address - Street 1:2534 ASHWOOD CT SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9210
Mailing Address - Country:US
Mailing Address - Phone:616-560-5475
Mailing Address - Fax:
Practice Address - Street 1:2534 ASHWOOD CT SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9210
Practice Address - Country:US
Practice Address - Phone:616-560-5475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)