Healthcare Provider Details

I. General information

NPI: 1699427377
Provider Name (Legal Business Name): KIMBER DECKER COUNSELING AND CONSULTATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 E BELTLINE AVE NE STE 303
GRAND RAPIDS MI
49525-9350
US

IV. Provider business mailing address

4829 E BELTLINE AVE NE STE 303
GRAND RAPIDS MI
49525-9350
US

V. Phone/Fax

Practice location:
  • Phone: 616-320-4664
  • Fax: 833-469-2110
Mailing address:
  • Phone: 616-320-4664
  • Fax: 833-469-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. KIMBER GLENN DECKER
Title or Position: OWNER, CEO, PROFESSIONAL COUNSELOR
Credential: MA LPC
Phone: 616-320-4664