Healthcare Provider Details

I. General information

NPI: 1265266498
Provider Name (Legal Business Name): KP AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 PENINSULAR DR SE STE 230
GRAND RAPIDS MI
49546-6187
US

IV. Provider business mailing address

3940 PENINSULAR DR SE STE 230
GRAND RAPIDS MI
49546-6187
US

V. Phone/Fax

Practice location:
  • Phone: 616-856-0037
  • Fax: 616-699-4750
Mailing address:
  • Phone: 616-856-0037
  • Fax: 616-699-4750

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: MR. KERBY KILLINGHAM
Title or Position: CLINICIAN
Credential: LPC
Phone: 616-856-0037