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General NPI Number Information
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NPI Number | 1710833520
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Entity Type | Organization
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Legal Business Name | WILLOW COUNSELING STUDIO
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 2424 BURTON ST SE STE 103
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-4833
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Country | US
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Telephone | 616-229-0671
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 CHAMBERLAIN AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4638
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Country | US
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Telephone | 616-229-0671
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | KYLENE RENEE DALTON-KOONS
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Credential | LMSW
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Telephone | 616-706-3951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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