Healthcare Provider Details

I. General information

NPI: 1619794260
Provider Name (Legal Business Name): CONCORDIA PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E BELTLINE AVE SE STE 350
GRAND RAPIDS MI
49506-4399
US

IV. Provider business mailing address

1550 E BELTLINE AVE SE STE 350
GRAND RAPIDS MI
49506-4399
US

V. Phone/Fax

Practice location:
  • Phone: 616-275-0705
  • Fax: 616-616-5620
Mailing address:
  • Phone: 616-275-0705
  • Fax: 616-616-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: SELINA HILL LEE
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 616-634-8958