Healthcare Provider Details

I. General information

NPI: 1306737796
Provider Name (Legal Business Name): MRJ COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E BELTLINE AVE NE STE 300
GRAND RAPIDS MI
49506-1267
US

IV. Provider business mailing address

2721 ALBERT DR SE
EAST GRAND RAPIDS MI
49506-4707
US

V. Phone/Fax

Practice location:
  • Phone: 231-920-3183
  • Fax:
Mailing address:
  • Phone: 231-920-3183
  • 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: MICHELE RAE ANNE JACKSON
Title or Position: OWNER
Credential: LMSW, PMH-C
Phone: 231-920-3183