Healthcare Provider Details

I. General information

NPI: 1689734642
Provider Name (Legal Business Name): ERIN MEG ELSEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN MEG BERTKE LPC

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4304
US

IV. Provider business mailing address

2621 OAKWOOD DR SE
GRAND RAPIDS MI
49506-4230
US

V. Phone/Fax

Practice location:
  • Phone: 616-356-6285
  • Fax: 616-732-6392
Mailing address:
  • Phone: 616-285-6114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009953
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: