Provider Demographics
NPI:1518277532
Name:KRUITHOFF, MARY D (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:D
Last Name:KRUITHOFF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:EVART
Mailing Address - State:MI
Mailing Address - Zip Code:49631-0084
Mailing Address - Country:US
Mailing Address - Phone:231-629-6393
Mailing Address - Fax:
Practice Address - Street 1:10039 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EVART
Practice Address - State:MI
Practice Address - Zip Code:49631-7313
Practice Address - Country:US
Practice Address - Phone:231-629-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011846101YP2500X
MI6301014054103TC1900X
MI6401017199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling