Healthcare Provider Details

I. General information

NPI: 1629874102
Provider Name (Legal Business Name): JEAN LINDA MAGUIRE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 KRAFT AVE SE
GRAND RAPIDS MI
49512-7700
US

IV. Provider business mailing address

417 S DESPELDER ST
GRAND HAVEN MI
49417-1910
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-9550
  • Fax: 616-949-9551
Mailing address:
  • Phone: 517-442-7014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401004117
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: