Healthcare Provider Details

I. General information

NPI: 1477019404
Provider Name (Legal Business Name): MELISSA MUIR COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 KENMOOR AVE SE STE 101A
GRAND RAPIDS MI
49546-8626
US

IV. Provider business mailing address

630 KENMOOR AVE SE STE 101A
GRAND RAPIDS MI
49546-8626
US

V. Phone/Fax

Practice location:
  • Phone: 616-446-8436
  • Fax: 616-920-6536
Mailing address:
  • Phone: 616-446-8436
  • Fax: 616-920-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MUIR
Title or Position: OWNER
Credential:
Phone: 616-446-8436