Healthcare Provider Details

I. General information

NPI: 1225691496
Provider Name (Legal Business Name): STEVEN EDELMAN LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 03/11/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 PLAINFIELD AVE NE UNIT 4
GRAND RAPIDS MI
49505
US

IV. Provider business mailing address

922 VIRGINIA ST SE
GRAND RAPIDS MI
49506-1511
US

V. Phone/Fax

Practice location:
  • Phone: 307-840-5122
  • Fax:
Mailing address:
  • Phone: 307-840-5122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401018336
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: