Healthcare Provider Details

I. General information

NPI: 1457874794
Provider Name (Legal Business Name): NATHANAEL CROPSEY LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MONROE AVE NW STE 400
GRAND RAPIDS MI
49503-2293
US

IV. Provider business mailing address

6758 E PRICE RD
SAINT JOHNS MI
48879-9188
US

V. Phone/Fax

Practice location:
  • Phone: 616-901-9507
  • Fax:
Mailing address:
  • Phone: 517-285-3895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016179
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: