| Second Story Counseling | |
|
3424 Chicago Dr Ste 205 Hudsonville MI 49426-1411 | |
| (616) 426-9034 | |
| Not Available |
| Full Name | Second Story Counseling |
|---|---|
| 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 |
|---|---|
| Second Story Counseling 7678 Cottonwood Dr Ste C Jenison MI 49428-7312 Ph: (616) 821-8723 | Second Story Counseling 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 | 9931468295 |
|---|---|
| Medicare Enrollment ID | O20180111001523 |
| 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 | Audrey C Aukeman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457805616 PECOS PAC ID: 5193173623 Enrollment ID: I20231122001041 |
| Provider Name | Kelsey A Rondeau |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457971152 PECOS PAC ID: 5597113761 Enrollment ID: I20231128003560 |
| 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 | Denise A Boldt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013452465 PECOS PAC ID: 6709234594 Enrollment ID: I20231205001642 |
| 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 |
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