Healthcare Provider Details

I. General information

NPI: 1699563213
Provider Name (Legal Business Name): CONSOLE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1643
US

IV. Provider business mailing address

4630 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1643
US

V. Phone/Fax

Practice location:
  • Phone: 616-259-4181
  • Fax:
Mailing address:
  • Phone: 616-259-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HAZELTINE
Title or Position: OWNER
Credential: LPC
Phone: 616-450-3771