Healthcare Provider Details

I. General information

NPI: 1235897026
Provider Name (Legal Business Name): CASEY COUNSELING & CONSULTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 KRAFT AVE SE STE 256
GRAND RAPIDS MI
49512-2076
US

IV. Provider business mailing address

2828 KRAFT AVE SE STE 256
GRAND RAPIDS MI
49512-2076
US

V. Phone/Fax

Practice location:
  • Phone: 616-304-3095
  • Fax: 616-483-0005
Mailing address:
  • Phone: 616-304-3095
  • Fax: 616-483-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. IVY KOWALSKI
Title or Position: OWNER
Credential: MA LPC
Phone: 616-304-3095