Healthcare Provider Details

I. General information

NPI: 1780021733
Provider Name (Legal Business Name): BRYAN NIXON COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

985 PARCHMENT DR SE
GRAND RAPIDS MI
49546-3659
US

IV. Provider business mailing address

985 PARCHMENT DR SE
GRAND RAPIDS MI
49546-3659
US

V. Phone/Fax

Practice location:
  • Phone: 616-425-2412
  • Fax:
Mailing address:
  • Phone: 616-425-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012317
License Number StateMI

VIII. Authorized Official

Name: BRYAN J NIXON
Title or Position: OWNER/COUNSELOR PROFESSIONAL
Credential: LPC
Phone: 616-881-1464