NPIMap

Organization Active NPI

Kristine Koetje Ma, PC

Doing business as Compassionate Christian Counseling

  • Psychologist
  • Spring Lake, MI
National Provider Identifier
1316010770
Registry record updated Nov 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301008186 Issued in MI
Legal business name
KRISTINE KOETJE MA, PC
Doing business as
Compassionate Christian Counseling
Practice address
17224 Van Wagoner Rd
Spring Lake, MI 49456-9702
Phone
(616) 296-2130
Fax
(616) 296-2148
NPI assigned
Nov 15, 2006
Last updated
Nov 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Kristine A Koetje, MA LLPNPI 1164595526
Title
President
Phone
(616) 296-2130

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6301008186 MI Primary

Addresses

Primary practice location

17224 Van Wagoner Rd
Spring Lake, MI 49456-9702

Mailing address

17224 Van Wagoner Rd
Spring Lake, MI 49456-9702
Phone (616) 296-2130

Other names 1

  • Compassionate Christian Counseling Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120229000489 MI Part B Supplier - Clinic/Group Practice 3375701873 Receives reassigned benefits from 35 practitioners
Practice locations: Spring Lake, MI; Jenison, MI

National Provider Directory

National Provider Directory

Locations

1388 Baldwin St
Ste A
Jenison, MI 49428
Phone (616) 259-9220

17222 Van Wagoner Rd
Spring Lake, MI 49456

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 43

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480464000000",
    "number": "1316010770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17224 VAN WAGONER RD",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494569702",
            "telephone_number": "616-296-2130",
            "fax_number": "616-296-2148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17224 VAN WAGONER RD",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494569702",
            "telephone_number": "616-296-2130",
            "fax_number": "616-296-2148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRISTINE KOETJE MA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2016-11-30",
        "status": "A",
        "authorized_official_last_name": "KOETJE",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-296-2130",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA LLP"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301008186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Compassionate Christian Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spring Lake, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.