Healthcare Provider Details

I. General information

NPI: 1871756841
Provider Name (Legal Business Name): WILLIAM P MCINNIS, PSY.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 3 MILE RD NW STE 101
GRAND RAPIDS MI
49544-8209
US

IV. Provider business mailing address

640 3 MILE RD NW STE 101
GRAND RAPIDS MI
49544-8209
US

V. Phone/Fax

Practice location:
  • Phone: 616-785-8900
  • Fax:
Mailing address:
  • Phone: 616-785-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberL947184
License Number StateMI

VIII. Authorized Official

Name: DR. WILLIAM P MCINNIS
Title or Position: OWNER
Credential:
Phone: 616-785-8900