Healthcare Provider Details

I. General information

NPI: 1811816788
Provider Name (Legal Business Name): ANDREA BONTRAGER COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 LAKESHORE DR APT C1
SAINT JOSEPH MI
49085-2943
US

IV. Provider business mailing address

3610 LAKESHORE DR APT C1
SAINT JOSEPH MI
49085-2943
US

V. Phone/Fax

Practice location:
  • Phone: 269-281-0063
  • Fax: 269-281-0102
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ANDREA J BONTRAGER
Title or Position: CEO
Credential:
Phone: 206-408-3046