Healthcare Provider Details

I. General information

NPI: 1609355486
Provider Name (Legal Business Name): CARRIE LYNN BUCHOLTZ MA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE LYNN LARSON

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S BRIDGE ST STE 1
BELDING MI
48809-1765
US

IV. Provider business mailing address

302 S BRIDGE ST STE 1
BELDING MI
48809-1765
US

V. Phone/Fax

Practice location:
  • Phone: 312-425-8768
  • Fax: 616-376-0912
Mailing address:
  • Phone: 231-425-8768
  • Fax: 616-376-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401016357
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401016357
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: