Healthcare Provider Details

I. General information

NPI: 1902255284
Provider Name (Legal Business Name): ALEXIS TERPSTRA BCBA, PSY.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 KNAPP ST NE
GRAND RAPIDS MI
49525-4518
US

IV. Provider business mailing address

1501 MASON ST NE
GRAND RAPIDS MI
49503-1331
US

V. Phone/Fax

Practice location:
  • Phone: 616-558-2885
  • Fax:
Mailing address:
  • Phone: 616-558-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB354690
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSP0000001061481
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: