Healthcare Provider Details

I. General information

NPI: 1740454420
Provider Name (Legal Business Name): TOPP PSYCHOLOGICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 CASCADE RD SE STE 1
GRAND RAPIDS MI
49546-3673
US

IV. Provider business mailing address

4403 CASCADE RD SE STE 1
GRAND RAPIDS MI
49546-3673
US

V. Phone/Fax

Practice location:
  • Phone: 616-975-0907
  • Fax: 616-975-3988
Mailing address:
  • Phone: 616-975-0907
  • Fax: 616-975-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberDT009389
License Number StateMI

VIII. Authorized Official

Name: DR. DONALD MARK TOPP
Title or Position: OWNER
Credential: PSY.D
Phone: 616-975-0907