=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164390134
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DCM5 LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2025
-----------------------------------------------------
Last Update Date | 10/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 534 FOUNTAIN ST NE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49503-3422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-779-3124
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1674 MONT RUE DR SE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-6438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-779-3124
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | COLLEEN M MRAZEK
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 630-779-3124
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------