Healthcare Provider Details

I. General information

NPI: 1831705433
Provider Name (Legal Business Name): MAEGAN MICHELLE PARKER LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 FRONT AVE NW STE 100
GRAND RAPIDS MI
49504-5323
US

IV. Provider business mailing address

700 LILAC AVE
BIG RAPIDS MI
49307-2520
US

V. Phone/Fax

Practice location:
  • Phone: 616-916-3711
  • Fax:
Mailing address:
  • Phone: 269-908-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401018638
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: