Healthcare Provider Details

I. General information

NPI: 1760367247
Provider Name (Legal Business Name): TENNYSON MACKEY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3532 RANGER DR UNIT 205
GRAND RAPIDS MI
49525-9813
US

IV. Provider business mailing address

2100 E BELTLINE AVE NE # 133
GRAND RAPIDS MI
49525-9708
US

V. Phone/Fax

Practice location:
  • Phone: 616-209-8759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TENNYSON DEWITT
Title or Position: OWNER/FOUNDER/COUNSELOR
Credential: MA, LPC
Phone: 616-209-8759