Healthcare Provider Details

I. General information

NPI: 1225969827
Provider Name (Legal Business Name): LAUREN PUCKETT COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5574 KELEKENT AVE SE
GRAND RAPIDS MI
49548-5849
US

IV. Provider business mailing address

5574 KELEKENT AVE SE
GRAND RAPIDS MI
49548-5849
US

V. Phone/Fax

Practice location:
  • Phone: 989-948-4449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LAUREN PUCKETT
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 616-810-9047