Provider Demographics
NPI:1952731192
Name:LISTENING EAR COUNSELING GROUP
Entity Type:Organization
Organization Name:LISTENING EAR COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLPC
Authorized Official - Phone:616-214-8690
Mailing Address - Street 1:3239 GIDDINGS AVENUE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508
Mailing Address - Country:US
Mailing Address - Phone:616-214-8690
Mailing Address - Fax:
Practice Address - Street 1:3239 GIDDINGS AVENUE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-214-8690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013745101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty