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General NPI Number Information
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NPI Number | 1275079923
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Entity Type | Organization
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Legal Business Name | KOOL COUNSELING, LLC
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Dates
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Enumeration Date | 01/18/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 2335 BURTON ST SE SUITE 130
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4669
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Country | US
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Telephone | 616-929-0189
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Fax | 616-773-1264
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Provider Business Mailing Address
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Address Line | 2335 BURTON ST SE SUITE 130
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4669
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Country | US
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Telephone | 616-929-0189
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Fax | 616-773-1264
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Authorized Official
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Title or Position | CEO
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Name | RACHAEL KOOL
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Credential | LPC
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Telephone | 616-929-0189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6401012123
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License Number State | MI
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