Healthcare Provider Details

I. General information

NPI: 1912578402
Provider Name (Legal Business Name): BRIAN CHARLES ULRICH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E BELTLINE AVE NE STE 300
GRAND RAPIDS MI
49506-1267
US

IV. Provider business mailing address

7879 GREEN LINKS DR SE
CALEDONIA MI
49316-7619
US

V. Phone/Fax

Practice location:
  • Phone: 616-460-2508
  • Fax:
Mailing address:
  • Phone: 616-460-2508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401225329
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: