Healthcare Provider Details

I. General information

NPI: 1730465378
Provider Name (Legal Business Name): MATTHEW COLLIN KRIEG M.A. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 01/31/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 GRAND RIDGE CT NE STE 200
GRAND RAPIDS MI
49525-7043
US

IV. Provider business mailing address

1750 GRAND RIDGE CT NE STE 200
GRAND RAPIDS MI
49525-7043
US

V. Phone/Fax

Practice location:
  • Phone: 616-426-9034
  • Fax:
Mailing address:
  • Phone: 616-426-9034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012729
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: