Healthcare Provider Details

I. General information

NPI: 1275171837
Provider Name (Legal Business Name): CINDY S URBAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 LEONARD ST NE
GRAND RAPIDS MI
49505-5650
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 616-956-1122
  • Fax:
Mailing address:
  • Phone: 616-281-6372
  • Fax: 616-281-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012928
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: