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General NPI Number Information
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NPI Number | 1437081932
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE COUNSELING GROUP PLLC
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 4301 CANAL AVE SW STE E
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City | GRANDVILLE
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State | MI
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Zip | 49418-2667
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Country | US
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Telephone | 616-253-6268
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Fax |
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Provider Business Mailing Address
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Address Line | 2295 VAN BUREN ST
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City | HUDSONVILLE
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State | MI
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Zip | 49426-6400
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Country | US
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Telephone | 616-401-2850
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK R DYKE
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Credential | LPC
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Telephone | 616-401-2850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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