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3424 Chicago Dr Ste 205 Hudsonville MI 49426-1411 | |
| (616) 426-9034 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 3424 Chicago Dr Ste 205, Hudsonville, Michigan |
| Authorized Official Name and Position | Michael Walton (OWNER) |
| Authorized Official Contact | 6164269034 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7678 Cottonwood Dr Ste C Jenison MI 49428-7312 Ph: (616) 821-8723 | 3424 Chicago Dr Ste 205 Hudsonville MI 49426-1411 Ph: (616) 426-9034 |
| NPI Number | 1013460716 |
|---|---|
| Provider Enumeration Date | 07/28/2016 |
| Last Update Date | 12/27/2021 |
| Certification Date | 12/27/2021 |
| Medicare PECOS PAC ID | 6204292063 |
|---|---|
| Medicare Enrollment ID | O20230520000165 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013460716 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Phillip L Nienhuis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205976784 PECOS PAC ID: 7618900762 Enrollment ID: I20050919000192 |
| Provider Name | Robert J Ritzema |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770612657 PECOS PAC ID: 9234303637 Enrollment ID: I20120823000881 |
| Provider Name | Olivia G Brower |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154970333 PECOS PAC ID: 2365833423 Enrollment ID: I20211228000116 |
| Provider Name | Lauren E Puckett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891246542 PECOS PAC ID: 5395192678 Enrollment ID: I20231108000542 |
| Provider Name | Diana L Simpson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770726663 PECOS PAC ID: 0143677187 Enrollment ID: I20231113001293 |
| Provider Name | Nicholas P Burner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336718477 PECOS PAC ID: 9638526601 Enrollment ID: I20231113002456 |
| Provider Name | Eric Winer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336711969 PECOS PAC ID: 6002264520 Enrollment ID: I20231122000635 |
| Provider Name | Mark L Holloway |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952805830 PECOS PAC ID: 1355799875 Enrollment ID: I20231122000693 |
| Provider Name | Danielle Fall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306427208 PECOS PAC ID: 6800244328 Enrollment ID: I20231122000713 |
| Provider Name | Ryan A Hannah |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669043428 PECOS PAC ID: 5799133211 Enrollment ID: I20231122000786 |
| Provider Name | Audrey C Aukeman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457805616 PECOS PAC ID: 5193173623 Enrollment ID: I20231122001041 |
| Provider Name | Michael B Hazeltine |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215413091 PECOS PAC ID: 7911355243 Enrollment ID: I20231128001505 |
| Provider Name | Matthew C Krieg |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730465378 PECOS PAC ID: 0042668253 Enrollment ID: I20231129000907 |
| Provider Name | Sara L Hoekstra |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063970192 PECOS PAC ID: 6901254119 Enrollment ID: I20231129001141 |
| Provider Name | Kimberly S Bytwerk |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417415829 PECOS PAC ID: 3577911502 Enrollment ID: I20231130002650 |
| Provider Name | William J Evans |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043774466 PECOS PAC ID: 3072961028 Enrollment ID: I20231130003340 |
| Provider Name | Tennyson Dewitt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174087118 PECOS PAC ID: 5395193346 Enrollment ID: I20231130003562 |
| Provider Name | Emily R Samuels |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891247185 PECOS PAC ID: 9638527435 Enrollment ID: I20231204002224 |
| Provider Name | Denise A Boldt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013452465 PECOS PAC ID: 6709234594 Enrollment ID: I20231205001642 |
| Provider Name | William E Robinson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124633185 PECOS PAC ID: 0244687531 Enrollment ID: I20231206002499 |
| Provider Name | Michael L Walton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730530569 PECOS PAC ID: 4981964475 Enrollment ID: I20231213002332 |
| Provider Name | Steven S Jahnke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447734520 PECOS PAC ID: 9830549757 Enrollment ID: I20231219000691 |
| Provider Name | Olivia C Campbell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457015745 PECOS PAC ID: 8921458688 Enrollment ID: I20231221002527 |
| Provider Name | Lauren A Sack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760901235 PECOS PAC ID: 0749630549 Enrollment ID: I20240112002522 |
| Provider Name | Leo Preston |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174160378 PECOS PAC ID: 5092159558 Enrollment ID: I20240223000454 |
| Provider Name | Todd Leva |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851096788 PECOS PAC ID: 4486090370 Enrollment ID: I20240314000302 |
| Provider Name | Nathanael S Cropsey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457874794 PECOS PAC ID: 4385084623 Enrollment ID: I20240502003715 |
| Provider Name | Laurel Backing |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093464026 PECOS PAC ID: 1153866140 Enrollment ID: I20240715001850 |
| Provider Name | Katherine Straus |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801644224 PECOS PAC ID: 8729523725 Enrollment ID: I20240715002096 |
| Provider Name | Samuel A Beals |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073572541 PECOS PAC ID: 8729975313 Enrollment ID: I20240729003457 |
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