Healthcare Provider Details

I. General information

NPI: 1376884858
Provider Name (Legal Business Name): MELISSA M PHEBUS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 E BRIDGE ST STE D1
ROCKFORD MI
49341-1601
US

IV. Provider business mailing address

1971 E BELTLINE AVE NE STE 106 #1423
GRAND RAPIDS MI
49525
US

V. Phone/Fax

Practice location:
  • Phone: 616-433-6192
  • Fax:
Mailing address:
  • Phone: 616-433-6192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberL2284802
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: