Healthcare Provider Details

I. General information

NPI: 1710472592
Provider Name (Legal Business Name): MARK DAVID STRUBLER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E BELTLINE AVE NE STE 300
GRAND RAPIDS MI
49506-1267
US

IV. Provider business mailing address

330 E BELTLINE AVE NE STE 300
GRAND RAPIDS MI
49506-1267
US

V. Phone/Fax

Practice location:
  • Phone: 616-537-6773
  • Fax:
Mailing address:
  • Phone: 616-537-6773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016711
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: