Healthcare Provider Details

I. General information

NPI: 1023169182
Provider Name (Legal Business Name): BEHAVIORAL RESOURCES AND INSTITUTE FOR NEUROPSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3292 EVERGREEN DR NE
GRAND RAPIDS MI
49525-9580
US

IV. Provider business mailing address

3292 EVERGREEN DR NE
GRAND RAPIDS MI
49525-9580
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-8920
  • Fax: 616-365-8971
Mailing address:
  • Phone: 616-365-8920
  • Fax: 616-365-8971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301009319
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801078171
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501001445
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801087563
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801087427
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201007284
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401009854
License Number StateMI
# 9
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088063
License Number StateMI
# 10
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801058552
License Number StateMI
# 11
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089203
License Number StateMI
# 12
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801058531
License Number StateMI
# 13
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085231
License Number StateMI
# 14
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301012443
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL PAUL WOLFF
Title or Position: CLINICAL NEUROPSYCHOLOGIST
Credential: PSY.D.
Phone: 616-365-8920