Healthcare Provider Details

I. General information

NPI: 1477565612
Provider Name (Legal Business Name): KELLY DIANE DARBY HOLDER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY DIANE DARBY-HOLDER PH.D.

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CHERRY ST SE
GRAND RAPIDS MI
49503-4608
US

IV. Provider business mailing address

200 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4502
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS016389
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019678
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2973
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: