Healthcare Provider Details

I. General information

NPI: 1629998489
Provider Name (Legal Business Name): KATY SANDISON COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 WOODMEADOW DR SE
GRAND RAPIDS MI
49546-8031
US

IV. Provider business mailing address

133 DALE ST NE
GRAND RAPIDS MI
49505-4615
US

V. Phone/Fax

Practice location:
  • Phone: 616-710-1861
  • Fax:
Mailing address:
  • Phone: 616-295-0832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE SANDISON
Title or Position: MASTERS LEVEL PSYCHOLOGIST
Credential: MA, LLP
Phone: 616-295-0832