Healthcare Provider Details

I. General information

NPI: 1326242736
Provider Name (Legal Business Name): BEHAVIOR HEALTH PARTNERS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5242 PLAINFIELD AVE NE STE A
GRAND RAPIDS MI
49525-1084
US

IV. Provider business mailing address

PO BOX 120125
GRAND RAPIDS MI
49528-0103
US

V. Phone/Fax

Practice location:
  • Phone: 616-235-2090
  • Fax: 616-235-2099
Mailing address:
  • Phone: 616-235-2090
  • Fax: 616-235-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIE L NUTKINS
Title or Position: MEMBER
Credential: PHD
Phone: 616-235-2090