Healthcare Provider Details

I. General information

NPI: 1811759947
Provider Name (Legal Business Name): TRISHA WAUN LMSW COUNSELING & THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 10/16/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 NORTHLAND DR NE
GRAND RAPIDS MI
49525-1073
US

IV. Provider business mailing address

1133 GRISWOLD ST SE
GRAND RAPIDS MI
49507-3812
US

V. Phone/Fax

Practice location:
  • Phone: 810-886-4019
  • Fax:
Mailing address:
  • Phone: 810-886-4019
  • 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: TRISHA M WAUN
Title or Position: OWNER/THERAPIST
Credential: LMSW, CAADC
Phone: 810-886-4019