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General NPI Number Information
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NPI Number | 1417778929
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Entity Type | Organization
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Legal Business Name | PERIPHERAL COUNSELING LLC
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 1971 E BELTLINE AVE NE STE 200E
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-7064
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Country | US
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Telephone | 989-745-1933
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Fax |
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Provider Business Mailing Address
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Address Line | 1510 DERBY DR NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-2678
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYLE HANDRICH
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Credential |
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Telephone | 989-745-1933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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