Healthcare Provider Details

I. General information

NPI: 1124491600
Provider Name (Legal Business Name): BENJAMIN ROY BOOKIE M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 S BRIDGE ST STE A
BELDING MI
48809-1764
US

IV. Provider business mailing address

3087 POTTERS RD
IONIA MI
48846-8514
US

V. Phone/Fax

Practice location:
  • Phone: 616-902-9007
  • Fax:
Mailing address:
  • Phone: 616-902-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6401015165
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401015165
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: