MEDICARE: HILLARY TAYLOR COOLBAUGH

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1922665710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HILLARY TAYLOR COOLBAUGH

Provider Business Mailing Address
First Line	:	648 MONROE AVE NW STE 100
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-6714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	678 FRONT AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-5325
Country	:	US
Telephone Number	:	616-916-3711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	08/13/2025

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