Healthcare Provider Details

I. General information

NPI: 1871960161
Provider Name (Legal Business Name): KATHERINE RUNDLE MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2015
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16220 CENTER RD
EAST LANSING MI
48823-9442
US

IV. Provider business mailing address

16220 CENTER RD
EAST LANSING MI
48823-9442
US

V. Phone/Fax

Practice location:
  • Phone: 989-329-7909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013951
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: