Healthcare Provider Details

I. General information

NPI: 1497629935
Provider Name (Legal Business Name): VICTOR GARCIA-CRUZ MA LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 MONROE AVE NW STE 323
GRAND RAPIDS MI
49505-4674
US

IV. Provider business mailing address

1345 MONROE AVE NW STE 323
GRAND RAPIDS MI
49505-4674
US

V. Phone/Fax

Practice location:
  • Phone: 616-284-1329
  • Fax:
Mailing address:
  • Phone: 616-284-1329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024265
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: