Healthcare Provider Details

I. General information

NPI: 1952157109
Provider Name (Legal Business Name): CHANNELING CHANGE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 CALKINS AVE SE UNIT E
GRAND RAPIDS MI
49506-1695
US

IV. Provider business mailing address

347 CALKINS AVE SE UNIT E
GRAND RAPIDS MI
49506-1695
US

V. Phone/Fax

Practice location:
  • Phone: 989-225-6657
  • Fax:
Mailing address:
  • Phone: 989-225-6657
  • 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: KYLENE FRANK
Title or Position: LMSW
Credential: LMSW
Phone: 989-225-6657