Healthcare Provider Details

I. General information

NPI: 1609292333
Provider Name (Legal Business Name): MICHAEL ROBERT RICHMAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 BRIDGE ST NW STE 3
GRAND RAPIDS MI
49504-5349
US

IV. Provider business mailing address

528 BRIDGE ST NW STE 3
GRAND RAPIDS MI
49504-5349
US

V. Phone/Fax

Practice location:
  • Phone: 616-888-4353
  • Fax: 833-777-2774
Mailing address:
  • Phone: 616-888-4353
  • Fax: 833-777-2774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012940
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: