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NPI Code Detail

MEDICARE: KOOL COUNSELING, LLC

MEDICARE: KOOL COUNSELING, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency6401012123MI

General Provider Information

NPI Number : 1275079923
Entity Type Code : Organization
Provider Name (Legal Business Name) : KOOL COUNSELING, LLC
Provider Business Mailing Address
First Line : 2335 BURTON ST SE
Second Line : SUITE 130
City : GRAND RAPIDS
State : MI
Zip : 49506-4669
Country : US
Telephone Number : 616-929-0189
Fax Number : 616-773-1264
Provider Business Practice Location Address
First Line : 2335 BURTON ST SE
Second Line : SUITE 130
City : GRAND RAPIDS
State : MI
Zip : 49506-4669
Country : US
Telephone Number : 616-929-0189
Fax Number : 616-773-1264
Authorized Official
Title or Position : CEO
Name : RACHAEL KOOL
Credential : LPC
Telephone Number : 616-929-0189
Provider Enumeration Date : 01/18/2017
Last Update Date : 01/19/2017

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