Organization
CREEKSIDE COUNSELING GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB GRINGORTEN TLLP (CLINICAL THERAPIST)
(248) 761-4059
Entity
Organization
Contact information
Practice address
10801 S SAGINAW ST STE D, GRAND BLANC, MI 48439-8126
(810) 771-4074
Mailing address
13308 TALBOT AVE, HUNTINGTON WOODS, MI 48070-1025
(248) 761-4059
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
09/17/2025
Last updated
09/17/2025
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