Healthcare Provider Details

I. General information

NPI: 1528806437
Provider Name (Legal Business Name): COMPASSIONATE COUCH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 BRETON RD SE STE 104
GRAND RAPIDS MI
49546-5547
US

IV. Provider business mailing address

2050 BRETON RD SE STE 104
GRAND RAPIDS MI
49546-5547
US

V. Phone/Fax

Practice location:
  • Phone: 616-227-0806
  • Fax: 616-226-4621
Mailing address:
  • Phone: 616-227-0806
  • Fax: 616-226-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. JULIE EDWARDS
Title or Position: EMPLOYEE
Credential: LLP, LPC
Phone: 616-227-0806