Healthcare Provider Details

I. General information

NPI: 1306426424
Provider Name (Legal Business Name): ALEX BRITO COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 MONROE AVE NW STE 209
GRAND RAPIDS MI
49505-4663
US

IV. Provider business mailing address

1047 CALIFORNIA ST NW
GRAND RAPIDS MI
49504-5403
US

V. Phone/Fax

Practice location:
  • Phone: 616-414-4197
  • Fax:
Mailing address:
  • Phone: 616-264-7907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL ALEJANDRO BRITO
Title or Position: DIRECTOR & LEAD THERAPIST
Credential: LPC
Phone: 616-414-4197