| NPI | 1003595448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE J DYKSTRA Clinical Psychologist 989-274-7219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-07-13 |
| Last Update Date | 2023-07-13 |