Individual
MICHELE A NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LLP, LLPC
Contact information
Practice address
200 IONIA AVE SW, SUITE 4112, GRAND RAPIDS, MI 49503-4116
(616) 283-3120
Mailing address
200 IONIA AVE SW, SUITE 4112, GRAND RAPIDS, MI 49503-4116
(616) 283-3120
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301013548
MI
103TC1900X
Counseling Psychologist
6401010610
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
05/05/2008
Last updated
12/07/2009
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