Healthcare Provider Details

I. General information

NPI: 1649927443
Provider Name (Legal Business Name): HOPE ON THE LAKESHORE THERAPY PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W WEBSTER AVE STE 301
MUSKEGON MI
49440-1294
US

IV. Provider business mailing address

221 W WEBSTER AVE STE 301
MUSKEGON MI
49440-1294
US

V. Phone/Fax

Practice location:
  • Phone: 517-525-9414
  • Fax:
Mailing address:
  • Phone: 517-525-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: HEATHER BROWN
Title or Position: OWNER
Credential:
Phone: 517-525-9414