Individual
MR. MICHAEL K. KIVINEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LLP, CHT
Contact information
Practice address
3210 EAGLE RUN DR, SUITE 200, GRAND RAPIDS, MI 49525
(616) 957-1200
(616) 957-1297
Mailing address
3210 EAGLE RUN DR, SUITE 200, GRAND RAPIDS, MI 49525
(616) 957-1200
(616) 957-1297
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
630101063
MI
1041C0700X
Clinical Social Worker
6801035811
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
04/29/2008
Last updated
06/26/2009
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