Healthcare Provider Details

I. General information

NPI: 1154478089
Provider Name (Legal Business Name): THE COUNSELING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9021 N RODGERS CT SE SUITE C
CALEDONIA MI
49316-7649
US

IV. Provider business mailing address

1773 WOODSIDE TRL NW
GRAND RAPIDS MI
49504-2580
US

V. Phone/Fax

Practice location:
  • Phone: 616-891-0287
  • Fax: 616-891-0873
Mailing address:
  • Phone: 616-453-1835
  • Fax: 616-453-1725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL STOWELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 269-795-4324