Healthcare Provider Details

I. General information

NPI: 1659214591
Provider Name (Legal Business Name): EASTOWN PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 WEALTHY ST SE STE 290
GRAND RAPIDS MI
49506-2755
US

IV. Provider business mailing address

1514 WEALTHY ST SE STE 290
GRAND RAPIDS MI
49506-2755
US

V. Phone/Fax

Practice location:
  • Phone: 616-706-4765
  • Fax:
Mailing address:
  • Phone: 616-706-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRISTIN ELIZABETH ROBERTS
Title or Position: CO-OWNER
Credential: PHD
Phone: 616-706-4765