Basic Information
| Provider Information | |||||||||
| NPI: | 1295201200 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENT COUNSELING AND PSYCHOLOGICAL SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 79TH ST SE | ||||||||
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| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495087241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168903292 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7920 KIRKLAND CT | ||||||||
| Address2: | |||||||||
| City: | PORTAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490244974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693817246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2018 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS GINEBAUGH | ||||||||
| AuthorizedOfficialFirstName: | KATHRYN | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6168903292 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.