Healthcare Provider Details

I. General information

NPI: 1124757182
Provider Name (Legal Business Name): KATIE PETERSON-BENSON MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 BURTON ST SE STE B
GRAND RAPIDS MI
49546-4810
US

IV. Provider business mailing address

115 PADDOCK AVE SE APT 2
GRAND RAPIDS MI
49506-1570
US

V. Phone/Fax

Practice location:
  • Phone: 616-226-6522
  • Fax: 616-608-6751
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401225342
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: