Healthcare Provider Details

I. General information

NPI: 1891215166
Provider Name (Legal Business Name): HORAK FAMILY AND PSYCHOLOGICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY AVE NW APT 443
GRAND RAPIDS MI
49504-4467
US

IV. Provider business mailing address

801 BROADWAY AVE NW APT 443
GRAND RAPIDS MI
49504-4467
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2327
  • Fax:
Mailing address:
  • Phone: 616-942-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE HELEN HORAK
Title or Position: CLINICIAN/OWNER
Credential:
Phone: 616-942-2327