Healthcare Provider Details

I. General information

NPI: 1407430044
Provider Name (Legal Business Name): ALLENA MAE PARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4065 E HILLS CT SE
GRAND RAPIDS MI
49546-6299
US

IV. Provider business mailing address

405 W GREENLAWN AVE STE 200
LANSING MI
48910-2889
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2081
  • Fax: 616-942-5932
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451024946
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: