Healthcare Provider Details

I. General information

NPI: 1124815147
Provider Name (Legal Business Name): MARIN OLIVER KEMPEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E WEST MAPLE RD STE 100
WALLED LAKE MI
48390-3571
US

IV. Provider business mailing address

509 W FOREST AVE APT 105
YPSILANTI MI
48197-8117
US

V. Phone/Fax

Practice location:
  • Phone: 248-313-2900
  • Fax:
Mailing address:
  • Phone: 248-727-7361
  • 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:
Title or Position:
Credential:
Phone: