Healthcare Provider Details

I. General information

NPI: 1265971121
Provider Name (Legal Business Name): PERIANNE MURPHY VANBELOIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 E PARIS AVE SE STE 300
GRAND RAPIDS MI
49546-8809
US

IV. Provider business mailing address

1680 E PARIS AVE SE STE 300
GRAND RAPIDS MI
49546-8809
US

V. Phone/Fax

Practice location:
  • Phone: 616-288-4561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number640105926
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101007178
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017274
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: