Healthcare Provider Details

I. General information

NPI: 1235504655
Provider Name (Legal Business Name): OLIVIA TORRES SPRAUER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLIVIA TORRES PSYD

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 KENMOOR AVE SE STE A
GRAND RAPIDS MI
49546-2390
US

IV. Provider business mailing address

3235 NE 45TH AVE
PORTLAND OR
97213-1143
US

V. Phone/Fax

Practice location:
  • Phone: 616-227-3423
  • Fax: 616-965-3968
Mailing address:
  • Phone: 503-773-4140
  • Fax: 503-427-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301018177
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301018177
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: