Healthcare Provider Details

I. General information

NPI: 1457962078
Provider Name (Legal Business Name): CAPPON CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4304
US

IV. Provider business mailing address

3413 TOMAHAWK DR SW
GRANDVILLE MI
49418-1961
US

V. Phone/Fax

Practice location:
  • Phone: 616-303-1313
  • Fax:
Mailing address:
  • Phone: 616-303-1313
  • 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: PETER CAPPON
Title or Position: OWNER
Credential: LPC
Phone: 616-202-8240