Provider Demographics
NPI:1629318852
Name:HOOGERHYDE, LAURA A (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:A
Last Name:HOOGERHYDE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15515 ROYAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9119
Mailing Address - Country:US
Mailing Address - Phone:616-502-8347
Mailing Address - Fax:
Practice Address - Street 1:120 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1410
Practice Address - Country:US
Practice Address - Phone:616-502-8347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional