Amy Kathleen Petersen, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401225669 Issued in MI

Practice address

440 S State St
Zeeland, MI 49464-2060

Phone

(616) 741-3790

Fax

(616) 741-3792

NPI assigned

Jun 23, 2023

Last updated

Aug 4, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grand Rapids Therapy Group Inc

  dba GR Therapy Group

  • Psychologist
  • Grand Rapids, MI
  • NPI 1295211076
  Medicare reassignment NPD
• Pine Rest Christian Mental Health Services

  • Professional Counselor
  • Grand Rapids, MI
  • NPI 1386015683
  NPD (past)

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

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785801600000",
    "number": "1750067823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 S STATE ST",
            "city": "ZEELAND",
            "state": "MI",
            "postal_code": "494642060",
            "telephone_number": "616-741-3790",
            "fax_number": "616-741-3792"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3424 Chicago Dr",
            "address_purpose": "LOCATION",
            "city": "Hudsonville",
            "state": "MI",
            "postal_code": "494261408",
            "country_code": "US",
            "telephone_number": "616-426-9034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "AMY",
        "middle_name": "KATHLEEN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-23",
        "last_updated": "2026-08-04",
        "certification_date": "2026-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401225669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sadie E Pashak
• Alissa Pavano
• Marcos Pedroza
• Kristin Pence, LPC
• Melodie Perkins, LLMSW
• Jami Michelle Petersen, MA, CCC-SLP
• Physical Therapy Services of Ottawa
• Physiotherapy Associates Inc
• Sandra Kay Pikaart, LPC
• Pine Rest Christian Mental Health Services

• Professional Counselor in Zeeland, MI
• Providers in Zeeland, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.