| NPI | 1053652909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA ANN KLOTT Owner 616-204-5828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301015303) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301015303) |
| 103TC1900X Psychologist, Counseling (Licence: MI 6301015303) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301015303) | |
| 103TF0000X Psychologist, Family (Licence: MI 6301015303) | |
| 103TH0100X Psychologist, Health Service (Licence: MI 6301015303) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301015303) | |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2014-03-18 |