Provider Demographics
NPI:1609432996
Name:KORNOELJE, ROBB (LPC)
Entity Type:Individual
Prefix:
First Name:ROBB
Middle Name:
Last Name:KORNOELJE
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 1:221 TROWBRIDGE ST NE APT 208
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1891
Mailing Address - Country:US
Mailing Address - Phone:616-499-7711
Mailing Address - Fax:
Practice Address - Street 1:221 TROWBRIDGE ST NE APT 208
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1891
Practice Address - Country:US
Practice Address - Phone:616-499-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI6401019612101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health