Healthcare Provider Details

I. General information

NPI: 1215420641
Provider Name (Legal Business Name): EMILY ANNA BROUWERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 KENMOOR AVE SE STE 301
GRAND RAPIDS MI
49546-2395
US

IV. Provider business mailing address

1451 LAKE DR SE # 6062
GRAND RAPIDS MI
49506-1760
US

V. Phone/Fax

Practice location:
  • Phone: 616-209-9142
  • Fax:
Mailing address:
  • Phone: 616-209-9142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016664
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: