Healthcare Provider Details

I. General information

NPI: 1922774975
Provider Name (Legal Business Name): TERESA GAYLE HULTINK MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 MONROE AVE NW STE 332
GRAND RAPIDS MI
49505-4673
US

IV. Provider business mailing address

1345 MONROE AVE NW STE 332
GRAND RAPIDS MI
49505-4673
US

V. Phone/Fax

Practice location:
  • Phone: 616-795-4335
  • Fax: 616-381-4089
Mailing address:
  • Phone: 616-795-4335
  • Fax: 616-381-4089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451019469
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: