Healthcare Provider Details

I. General information

NPI: 1083493845
Provider Name (Legal Business Name): MI PROFESSIONAL COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 02/23/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5242 PLAINFIELD AVE NE STE F
GRAND RAPIDS MI
49525-1084
US

IV. Provider business mailing address

PO BOX 2023
GRAND RAPIDS MI
49501-2023
US

V. Phone/Fax

Practice location:
  • Phone: 616-426-9226
  • Fax: 616-825-5980
Mailing address:
  • Phone: 616-426-9226
  • Fax: 616-825-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAURIE-LYNN DIX SCHMIT
Title or Position: OWNER
Credential: LMSW
Phone: 616-426-9226