Healthcare Provider Details

I. General information

NPI: 1811474554
Provider Name (Legal Business Name): 8TH STREET COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 E 8TH ST STE 230
HOLLAND MI
49423-3561
US

IV. Provider business mailing address

44 E 8TH ST STE 230
HOLLAND MI
49423-3561
US

V. Phone/Fax

Practice location:
  • Phone: 616-613-6753
  • Fax: 616-984-4568
Mailing address:
  • Phone: 616-613-6753
  • Fax: 616-984-4568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6801093598
License Number StateMI

VIII. Authorized Official

Name: MRS. SANDY KEMINK
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LMSW
Phone: 616-613-6753