Provider Demographics
NPI:1588901029
Name:KOOI, WILLIAM BLAKE (MA, LPC, QIDP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BLAKE
Last Name:KOOI
Suffix:
Gender:M
Credentials:MA, LPC, QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 FOUNTAIN ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3632
Mailing Address - Country:US
Mailing Address - Phone:616-710-1504
Mailing Address - Fax:
Practice Address - Street 1:534 FOUNTAIN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3422
Practice Address - Country:US
Practice Address - Phone:616-710-1504
Practice Address - Fax:616-456-1324
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI6401014874101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator