Healthcare Provider Details

I. General information

NPI: 1629168034
Provider Name (Legal Business Name): JOSEPH J. HORAK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 E PARIS AVE SE STE. 220
GRAND RAPIDS MI
49546-8371
US

IV. Provider business mailing address

1179 E PARIS AVE SE STE. 220
GRAND RAPIDS MI
49546-8371
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-2327
  • Fax: 616-454-0061
Mailing address:
  • Phone: 616-942-2327
  • Fax: 616-454-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301012066
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: