Healthcare Provider Details

I. General information

NPI: 1144762840
Provider Name (Legal Business Name): COLETTE MARIE SCHIPPERS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

IV. Provider business mailing address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

V. Phone/Fax

Practice location:
  • Phone: 616-281-6372
  • Fax: 641-672-3259
Mailing address:
  • Phone: 616-455-5000
  • Fax: 616-455-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401018778
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number084505
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: