Healthcare Provider Details

I. General information

NPI: 1205750825
Provider Name (Legal Business Name): KEVIN MAYBURY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 S WAVERLY RD STE 103
HOLLAND MI
49423-8101
US

IV. Provider business mailing address

790 SOUTHGATE ST
HOLLAND MI
49423-4557
US

V. Phone/Fax

Practice location:
  • Phone: 616-218-4769
  • Fax:
Mailing address:
  • Phone: 616-218-4769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MAYBURY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 616-218-4769