Healthcare Provider Details

I. General information

NPI: 1205153574
Provider Name (Legal Business Name): LYNN MARIE HECHT SIEGEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN HECHT GILCHRIST

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 NORTHLAND DR NE STE B
GRAND RAPIDS MI
49525-1073
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 616-229-0470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011381
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: