Healthcare Provider Details

I. General information

NPI: 1528761053
Provider Name (Legal Business Name): BOOKER BEHAVIOR THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 CASS AVE SE
GRAND RAPIDS MI
49503-5205
US

IV. Provider business mailing address

559 CASS AVE SE
GRAND RAPIDS MI
49503-5205
US

V. Phone/Fax

Practice location:
  • Phone: 616-840-3759
  • Fax:
Mailing address:
  • Phone: 616-315-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: AIKELAH BOOKER
Title or Position: BCBA
Credential:
Phone: 616-315-1011