Sacred Space Counseling

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401009234 Issued in MI

Legal business name

SACRED SPACE COUNSELING

Practice address

17214 Van Wagoner Rd
Spring Lake, MI 49456-9702

Phone

(616) 405-4188

Fax

(616) 935-1288

NPI assigned

Aug 29, 2012

Organization subpart

No

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

Authorized official

Name

Robert Deckert, LPC

Title

President

Phone

(616) 405-4188

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431388800000",
    "number": "1487902003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17214 VAN WAGONER RD",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494569702",
            "telephone_number": "616-405-4188",
            "fax_number": "616-935-1288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17214 VAN WAGONER RD",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494569702",
            "telephone_number": "616-405-4188",
            "fax_number": "616-935-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED SPACE COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-29",
        "last_updated": "2015-05-12",
        "status": "A",
        "authorized_official_last_name": "DECKERT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-405-4188",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401009234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.