Provider Demographics
NPI:1053053207
Name:THE ANXIETY CLINIC LLC
Entity type:Organization
Organization Name:THE ANXIETY CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:C
Authorized Official - Last Name:REIDER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-209-9277
Mailing Address - Street 1:2920 FULLER AVE NE STE 203
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3458
Mailing Address - Country:US
Mailing Address - Phone:616-209-9277
Mailing Address - Fax:
Practice Address - Street 1:2920 FULLER AVE NE STE 203
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3458
Practice Address - Country:US
Practice Address - Phone:616-209-9277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty