Healthcare Provider Details

I. General information

NPI: 1558246280
Provider Name (Legal Business Name): RELATIONAL THERAPY COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 MONROE CENTER ST NW STE 1104
GRAND RAPIDS MI
49503-2820
US

IV. Provider business mailing address

1809 COLLEGE AVE SE
GRAND RAPIDS MI
49507-2621
US

V. Phone/Fax

Practice location:
  • Phone: 616-626-1082
  • Fax:
Mailing address:
  • Phone: 616-209-8854
  • 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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JACOB MOON
Title or Position: OWNER
Credential: LMFT, LPC
Phone: 616-209-8854