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General NPI Number Information
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NPI Number | 1962716563
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Entity Type | Individual
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Provider Name | ANDREW J BOEKESTEIN LPC
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Gender | Male
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 12/22/2024
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Provider Practice Location Address
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Address Line | 103 COLLEGE AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-5921
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Country | US
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Telephone | 616-439-2005
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 TIMBER CANYON DR SE
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City | ADA
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State | MI
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Zip | 49301-8772
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Country | US
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Telephone | 616-528-2846
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401012220
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License Number State | MI
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