Healthcare Provider Details

I. General information

NPI: 1619885126
Provider Name (Legal Business Name): KATIE JO BRUINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W WASHINGTON AVE STE 280
ZEELAND MI
49464-1074
US

IV. Provider business mailing address

201 W WASHINGTON AVE STE 280
ZEELAND MI
49464-1074
US

V. Phone/Fax

Practice location:
  • Phone: 616-259-5452
  • Fax: 616-236-0875
Mailing address:
  • Phone: 616-259-5452
  • Fax: 616-236-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451024621
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: