Healthcare Provider Details

I. General information

NPI: 1710814140
Provider Name (Legal Business Name): STACEY PALMBERG LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY KLINGBERG

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 WASHINGTON AVE BLDG B
HOLLAND MI
49423-7144
US

IV. Provider business mailing address

198 W 15TH ST
HOLLAND MI
49423-3316
US

V. Phone/Fax

Practice location:
  • Phone: 616-355-3926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024516
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: