Healthcare Provider Details

I. General information

NPI: 1316872534
Provider Name (Legal Business Name): CREATIVE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 KENMOOR AVE SE STE A
GRAND RAPIDS MI
49546-2390
US

IV. Provider business mailing address

2614 RICHARDS DR SE
GRAND RAPIDS MI
49506-4736
US

V. Phone/Fax

Practice location:
  • Phone: 616-227-3423
  • Fax:
Mailing address:
  • Phone: 616-446-7710
  • 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: KERRY L HUVER
Title or Position: COUNSELOR
Credential: MPS, LPC
Phone: 616-446-7710