Healthcare Provider Details

I. General information

NPI: 1962716563
Provider Name (Legal Business Name): ANDREW J BOEKESTEIN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 TIMBER CANYON DR SE
ADA MI
49301-8772
US

IV. Provider business mailing address

1801 TIMBER CANYON DR SE
ADA MI
49301-8772
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-3055
  • Fax:
Mailing address:
  • Phone: 616-528-2846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012220
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: