Healthcare Provider Details

I. General information

NPI: 1366351322
Provider Name (Legal Business Name): ELIZABETH ROSE COLLETTI ROONEY LLMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH ROSE COLLETTI LIQUIGLI

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 29TH ST SE STE B8A
GRAND RAPIDS MI
49508-1565
US

IV. Provider business mailing address

2215 29TH ST SE STE B8A
GRAND RAPIDS MI
49508-1565
US

V. Phone/Fax

Practice location:
  • Phone: 616-404-7004
  • Fax:
Mailing address:
  • Phone: 616-404-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4151001235
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: