Healthcare Provider Details

I. General information

NPI: 1811249691
Provider Name (Legal Business Name): SARAH E.W. KOON LMHC, LCAC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 LEONARD ST NE
GRAND RAPIDS MI
49503-1138
US

IV. Provider business mailing address

105 ROLLINGROCK DR
ROCKFORD MI
49341-1197
US

V. Phone/Fax

Practice location:
  • Phone: 616-451-2021
  • Fax:
Mailing address:
  • Phone: 517-448-0228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA9927
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA9927
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6401016578
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87001563A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3072-A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: