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General NPI Number Information
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NPI Number | 1306554282
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Entity Type | Organization
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Legal Business Name | GRAND RAPIDS COUNSELING AND CONSULTATION
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 1239 76TH ST SW STE H4
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City | BYRON CENTER
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State | MI
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Zip | 49315-7921
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Country | US
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Telephone | 616-780-1243
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Fax |
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Provider Business Mailing Address
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Address Line | 769 SUN STONE DR SW
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City | BYRON CENTER
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State | MI
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Zip | 49315-8396
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Country | US
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Telephone | 616-258-6270
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY IBARRA
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Credential | MA, LPC, SCL
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Telephone | 616-258-6270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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