Healthcare Provider Details

I. General information

NPI: 1710673348
Provider Name (Legal Business Name): GRUPPEN PSYCHOLOGY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 KENMOOR AVE SE # 303
GRAND RAPIDS MI
49546-8622
US

IV. Provider business mailing address

PO BOX 140241
GRAND RAPIDS MI
49514-0241
US

V. Phone/Fax

Practice location:
  • Phone: 734-649-7906
  • Fax:
Mailing address:
  • Phone: 734-649-7906
  • 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: TIMOTHY GRUPPEN
Title or Position: OWNER
Credential: PSYD
Phone: 734-649-7906