Healthcare Provider Details

I. General information

NPI: 1962739284
Provider Name (Legal Business Name): AARON GOODRICH MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCRIBNER AVE NW
GRAND RAPIDS MI
49504-4424
US

IV. Provider business mailing address

350 SCOTT AVE NW
GRAND RAPIDS MI
49504-4964
US

V. Phone/Fax

Practice location:
  • Phone: 616-287-4161
  • Fax:
Mailing address:
  • Phone: 616-287-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011490
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: