Healthcare Provider Details

I. General information

NPI: 1902073653
Provider Name (Legal Business Name): PSYCHOLOGICAL HEALTH CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 S DESPELDER ST
GRAND HAVEN MI
49417-2649
US

IV. Provider business mailing address

1703 S DESPELDER ST
GRAND HAVEN MI
49417-2649
US

V. Phone/Fax

Practice location:
  • Phone: 616-842-1277
  • Fax: 616-842-4190
Mailing address:
  • Phone: 616-842-1277
  • Fax: 616-842-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD PATRICK MOSS
Title or Position: OWNER
Credential: PHD
Phone: 616-842-1277