MEDICARE: GRAND RAPIDS COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	6401009578	MI
2	101YP2500X	Professional Counselor	6401009578	MI

General Provider Information

NPI Number	:	1629597166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND RAPIDS COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	2400 EASTERN AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3632
Country	:	US
Telephone Number	:	616-988-3433
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 EASTERN AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3632
Country	:	US
Telephone Number	:	616-988-3433
Fax Number	:

Authorized Official
Title or Position	:	OWNER / EXECUTIVE DIRECTOR
Name	:	MR. SEAN ALEXANDER ROBINSON
Credential	:	LPC
Telephone Number	:	616-988-3433

Provider Enumeration Date	:	09/15/2017
Last Update Date	:	09/30/2024

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