Healthcare Provider Details

I. General information

NPI: 1518326511
Provider Name (Legal Business Name): KATELYN CABLE M.A., LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1050
US

IV. Provider business mailing address

5001 PLAINFIELD AVE NE STE B
GRAND RAPIDS MI
49525-1050
US

V. Phone/Fax

Practice location:
  • Phone: 616-278-0551
  • Fax: 616-278-0145
Mailing address:
  • Phone: 616-278-0551
  • Fax: 616-278-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6361001948
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361001948
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: