Healthcare Provider Details

I. General information

NPI: 1467789032
Provider Name (Legal Business Name): STEVEN KREITZER LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MONROE AVE NW SUITE 400
GRAND RAPIDS MI
49503-2211
US

IV. Provider business mailing address

715 3 MILE RD NE
GRAND RAPIDS MI
49505-3348
US

V. Phone/Fax

Practice location:
  • Phone: 616-558-6525
  • Fax:
Mailing address:
  • Phone: 616-558-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011650
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: