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NPI Code Detail

MEDICARE: SARAH ELIZABETH COVILLE MA LLP

MEDICARE: SARAH ELIZABETH COVILLE MA LLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist6301013253MI

General Provider Information

NPI Number : 1528364502
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH ELIZABETH COVILLE MA LLP
Provider Business Mailing Address
First Line : 826 PARCHMENT DR SE STE 205
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-2307
Country : US
Telephone Number : 616-893-0983
Fax Number : 616-930-4669
Provider Business Practice Location Address
First Line : 826 PARCHMENT DR SE STE 205
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-2307
Country : US
Telephone Number : 616-893-0983
Fax Number : 616-930-4669
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2011
Last Update Date : 11/04/2025

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