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General NPI Number Information
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NPI Number | 1164982849
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Entity Type | Organization
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Legal Business Name | KRYSTAL STROTBAUM LMFT LLC
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 2900 CHARLEVOIX DR SE STE 360
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7049
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Country | US
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Telephone | 616-229-0400
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Fax | 616-591-5624
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Provider Business Mailing Address
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Address Line | 2900 CHARLEVOIX DR SE STE 360
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7049
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Country | US
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Telephone | 616-229-0400
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Fax | 616-591-5624
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Authorized Official
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Title or Position | OWNER
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Name | KRYSTAL STROTBAUM
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Credential | LMFT
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Telephone | 616-229-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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