Healthcare Provider Details

I. General information

NPI: 1265399430
Provider Name (Legal Business Name): GRACE LUCILLE SCHILP MA, LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 TROWBRIDGE ST NE
GRAND RAPIDS MI
49503-1885
US

IV. Provider business mailing address

6815 CRESTWAY DR
BLOOMFIELD HILLS MI
48301-2810
US

V. Phone/Fax

Practice location:
  • Phone: 248-949-8014
  • Fax:
Mailing address:
  • Phone: 248-949-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024786
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: