is a Health Service in Grand Rapids, Michigan. practices all healthcare services and medical treatments related to Health Service. The NPI Number for is 1356508295. The last update date is .
's current location address is 330 Barclay Ave Ne, Grand Rapids, Michigan. You can contact this provider via phone number 6163912802 and fax number 6163912840. The mailing address for is 330 Barclay Ave Ne, Grand Rapids, Michigan. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 330 Barclay Ave Ne, Grand Rapids, Michigan |
| Phone Number | 6163912802 |
| Fax Number | 6163912840 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1356508295 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 330 Barclay Ave Ne |
|---|---|
| City | Grand Rapids |
| State | Michigan (MI) |
| Post Code | 495032556 |
| Phone Number | 6163912802 |
| Fax Number | 6163912840 |
Provider's Primary Taxonomy Detail
| Speciality | Health Service |
|---|---|
| Taxonomy | 103Th0100X |
| Licence No | 6301013341 |
|
Definition: A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustm |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1356508295 | MI | -- |
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