Healthcare Provider Details

I. General information

NPI: 1184410276
Provider Name (Legal Business Name): PAUL MICHAEL ALLISON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5899 STONYHILL LN SE
KENTWOOD MI
49508-6410
US

IV. Provider business mailing address

5899 STONYHILL LN SE
KENTWOOD MI
49508-6410
US

V. Phone/Fax

Practice location:
  • Phone: 616-209-9126
  • Fax:
Mailing address:
  • Phone: 616-209-9126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88000140A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401225274
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: