Healthcare Provider Details

I. General information

NPI: 1881910198
Provider Name (Legal Business Name): FREEDOM COUNSELING AND EDUCATION CENTER, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 E BELTLINE AVE NE SUITE 103
GRAND RAPIDS MI
49525-9747
US

IV. Provider business mailing address

4829 E BELTLINE AVE NE SUITE 103
GRAND RAPIDS MI
49525-9747
US

V. Phone/Fax

Practice location:
  • Phone: 616-734-9417
  • Fax:
Mailing address:
  • Phone: 616-734-9417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010812
License Number StateMI

VIII. Authorized Official

Name: MR. JONATHAN MULDER
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, LLPC, LLMFT
Phone: 616-734-9417