Healthcare Provider Details

I. General information

NPI: 1336712561
Provider Name (Legal Business Name): GRAND RAPIDS PSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2021
Last Update Date: 07/24/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 CASCADE RD SE STE 8
GRAND RAPIDS MI
49546-3673
US

IV. Provider business mailing address

1186 OAKBURN AVE SE
GRAND RAPIDS MI
49546-3767
US

V. Phone/Fax

Practice location:
  • Phone: 616-915-8153
  • Fax:
Mailing address:
  • Phone: 616-915-8153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. STACEY MORGAN
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 616-915-8153