Healthcare Provider Details

I. General information

NPI: 1649902701
Provider Name (Legal Business Name): OLIVIA BRENNINKMEIJER MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 E BELTLINE AVE NE STE 302
GRAND RAPIDS MI
49525-9350
US

IV. Provider business mailing address

2717 MAPLEWOOD DR SE
EAST GRAND RAPIDS MI
49506-4729
US

V. Phone/Fax

Practice location:
  • Phone: 616-226-6522
  • Fax:
Mailing address:
  • Phone: 231-866-1160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401225492
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: