Provider Demographics
NPI:1437590353
Name:VANBEMMELEN, ASHLEY NICHOLS (LPC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:NICHOLS
Last Name:VANBEMMELEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ANN
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2698 DUNNIGAN AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9624
Mailing Address - Country:US
Mailing Address - Phone:616-294-0040
Mailing Address - Fax:844-296-0280
Practice Address - Street 1:826 PARCHMENT DR SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-294-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013458101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional