Healthcare Provider Details

I. General information

NPI: 1104502673
Provider Name (Legal Business Name): EMILY MORGAN DUNHAM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 BALDWIN ST
JENISON MI
49428-8937
US

IV. Provider business mailing address

1600 SOUTHLAWN ST
JENISON MI
49428-8970
US

V. Phone/Fax

Practice location:
  • Phone: 616-765-8585
  • Fax:
Mailing address:
  • Phone: 616-304-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401226407
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: