Healthcare Provider Details

I. General information

NPI: 1790663078
Provider Name (Legal Business Name): MENUEZ HOLISTIC COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LEONARD ST NE
GRAND RAPIDS MI
49505-5515
US

IV. Provider business mailing address

2436 SANTA MONICA DR SE
EAST GRAND RAPIDS MI
49506-3548
US

V. Phone/Fax

Practice location:
  • Phone: 616-217-9964
  • Fax:
Mailing address:
  • Phone: 616-217-9964
  • 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: CATHY GALLEGOS
Title or Position: OWNER
Credential: LPC
Phone: 517-204-1270