Healthcare Provider Details

I. General information

NPI: 1851084354
Provider Name (Legal Business Name): SARAJANE ANN HERRBOLDT LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 E PARIS AVE SE STE 201
GRAND RAPIDS MI
49546-2426
US

IV. Provider business mailing address

1935 CHAMBERLAIN AVE SE
GRAND RAPIDS MI
49506-4638
US

V. Phone/Fax

Practice location:
  • Phone: 616-541-0433
  • Fax:
Mailing address:
  • Phone: 616-284-1604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023059
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: