Provider Demographics
NPI:1609292333
Name:RICHMAN, MICHAEL ROBERT (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:RICHMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 BRIDGE ST NW STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5349
Mailing Address - Country:US
Mailing Address - Phone:616-888-4353
Mailing Address - Fax:833-777-2774
Practice Address - Street 1:528 BRIDGE ST NW STE 3
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5349
Practice Address - Country:US
Practice Address - Phone:616-888-4353
Practice Address - Fax:833-777-2774
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional