Provider Demographics
NPI:1861285876
Name:VERBEEK, BLAKETON
Entity type:Individual
Prefix:
First Name:BLAKETON
Middle Name:
Last Name:VERBEEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MARKET AVE SW APT 549
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4093
Mailing Address - Country:US
Mailing Address - Phone:616-644-5201
Mailing Address - Fax:
Practice Address - Street 1:1055 GEZON PKWY SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-9542
Practice Address - Country:US
Practice Address - Phone:616-773-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty