Healthcare Provider Details

I. General information

NPI: 1962385989
Provider Name (Legal Business Name): ASHLEY NICOLE THOMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 BURTON ST SE STE 101
GRAND RAPIDS MI
49546-4800
US

IV. Provider business mailing address

260 FULLER AVE SE APT 2
GRAND RAPIDS MI
49506-1675
US

V. Phone/Fax

Practice location:
  • Phone: 616-309-0737
  • Fax:
Mailing address:
  • Phone: 616-287-2239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025002
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: