Healthcare Provider Details

I. General information

NPI: 1730655317
Provider Name (Legal Business Name): OLIVIA TORRES PSYD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/25/2018
Certification Date:
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

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

V. Phone/Fax

Practice location:
  • Phone: 309-208-6430
  • Fax: 616-965-3968
Mailing address:
  • Phone: 309-208-6430
  • Fax: 616-965-3968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. OLIVIA R TORRES
Title or Position: PSYCHOLOGIST RESIDENT
Credential: PSYD
Phone: 309-208-6430