| NPI | 1861930158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACEANN ROBERTSON Clinical Psychologist 616-443-6270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301008866) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2019-01-22 |