Healthcare Provider Details

I. General information

NPI: 1861834293
Provider Name (Legal Business Name): AMY KERIN CREAGH MA LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 KENMOOR AVE SE STE 301
GRAND RAPIDS MI
49546-2395
US

IV. Provider business mailing address

PO BOX 45
LOWELL MI
49331-0045
US

V. Phone/Fax

Practice location:
  • Phone: 616-319-1255
  • Fax:
Mailing address:
  • Phone: 616-319-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401223849
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6361000399
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: