Healthcare Provider Details

I. General information

NPI: 1588120737
Provider Name (Legal Business Name): THE CLINICIAN COLLECTIVE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 ELEANOR ST
KALAMAZOO MI
49007-3710
US

IV. Provider business mailing address

522 ELEANOR ST
KALAMAZOO MI
49007-3710
US

V. Phone/Fax

Practice location:
  • Phone: 269-903-4535
  • Fax: 269-775-1054
Mailing address:
  • Phone: 269-903-4535
  • Fax: 269-775-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CIJI C. GAMBLE
Title or Position: OWNER, COUNSELOR
Credential: MA, LPC
Phone: 269-903-4535