Provider Demographics
NPI:1902393440
Name:CAPTIVE BELIEFS COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:CAPTIVE BELIEFS COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BREANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:906-250-8855
Mailing Address - Street 1:13 WALLINWOOD AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3719
Mailing Address - Country:US
Mailing Address - Phone:906-250-8855
Mailing Address - Fax:
Practice Address - Street 1:13 WALLINWOOD AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3719
Practice Address - Country:US
Practice Address - Phone:231-753-8823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010935081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty