Healthcare Provider Details

I. General information

NPI: 1790398121
Provider Name (Legal Business Name): CENTER FOR NEUROPSYCHOLOGY AND BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E BELTLINE AVE SE STE 250
GRAND RAPIDS MI
49506-4364
US

IV. Provider business mailing address

1550 E BELTLINE AVE SE STE 250
GRAND RAPIDS MI
49506-4364
US

V. Phone/Fax

Practice location:
  • Phone: 616-862-5603
  • Fax:
Mailing address:
  • Phone: 616-862-5603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CRYSTAL YOUNG
Title or Position: OWNER
Credential: PHD
Phone: 616-862-5603