Provider Demographics
NPI:1013060151
Name:COUNSELING & CONSULTATION RESOURCES PC
Entity type:Organization
Organization Name:COUNSELING & CONSULTATION RESOURCES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ELLENS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:616-355-0549
Mailing Address - Street 1:720 E 8TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3079
Mailing Address - Country:US
Mailing Address - Phone:616-355-0549
Mailing Address - Fax:616-355-0480
Practice Address - Street 1:720 E 8TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3079
Practice Address - Country:US
Practice Address - Phone:616-355-0549
Practice Address - Fax:616-355-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-20
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011810261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)