Provider Demographics
NPI:1275395204
Name:RAAD, MICHAEL LEE (MA, LLC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:RAAD
Suffix:
Gender:M
Credentials:MA, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13725 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-9728
Mailing Address - Country:US
Mailing Address - Phone:616-292-2239
Mailing Address - Fax:
Practice Address - Street 1:3424 CHICAGO DR STE 205
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-1411
Practice Address - Country:US
Practice Address - Phone:616-426-9034
Practice Address - Fax:616-404-4103
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023442101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor