Healthcare Provider Details

I. General information

NPI: 1437764537
Provider Name (Legal Business Name): ELISHA CASTLE M.A., LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 29TH ST SE UNIT B8A
GRAND RAPIDS MI
49508-1565
US

IV. Provider business mailing address

2215 29TH ST SE UNIT B8A
GRAND RAPIDS MI
49508-1565
US

V. Phone/Fax

Practice location:
  • Phone: 616-404-7004
  • Fax:
Mailing address:
  • Phone: 616-404-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025089
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: