Provider Demographics
NPI:1861665473
Name:RAYBROOK COUNSELING GROUP LLC
Entity type:Organization
Organization Name:RAYBROOK COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY ELLEN
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BERTLING-SAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:616-977-5200
Mailing Address - Street 1:2020 RAYBROOK ST SE
Mailing Address - Street 2:SUITE 104-A
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7717
Mailing Address - Country:US
Mailing Address - Phone:616-977-5200
Mailing Address - Fax:866-721-6199
Practice Address - Street 1:2020 RAYBROOK ST SE
Practice Address - Street 2:SUITE 104-A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7717
Practice Address - Country:US
Practice Address - Phone:616-977-5200
Practice Address - Fax:866-721-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007799101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty