Provider Demographics
NPI:1760943278
Name:KJ COUNSELING LLC
Entity Type:Organization
Organization Name:KJ COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CRABB
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-502-8586
Mailing Address - Street 1:3090 AMON AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-3059
Mailing Address - Country:US
Mailing Address - Phone:616-502-8586
Mailing Address - Fax:
Practice Address - Street 1:4829 E BELTLINE AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9349
Practice Address - Country:US
Practice Address - Phone:616-364-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)