Healthcare Provider Details

I. General information

NPI: 1215507561
Provider Name (Legal Business Name): SACRED GROUND COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1108 LEONARD ST NE
GRAND RAPIDS MI
49503-1274
US

IV. Provider business mailing address

1108 LEONARD ST NE
GRAND RAPIDS MI
49503-1274
US

V. Phone/Fax

Practice location:
  • Phone: 616-238-0403
  • Fax:
Mailing address:
  • Phone: 616-238-0403
  • Fax:

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: MEGAN BESEMER
Title or Position: OWNER/THERAPIST
Credential: LMSW, CAADC
Phone: 616-238-0403