Healthcare Provider Details

I. General information

NPI: 1932923596
Provider Name (Legal Business Name): HOLLAND PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MONROE AVE NW # 2511
GRAND RAPIDS MI
49503-2211
US

IV. Provider business mailing address

6143 MADISON ST
COLOMA MI
49038-9335
US

V. Phone/Fax

Practice location:
  • Phone: 313-424-9995
  • Fax:
Mailing address:
  • Phone: 313-424-9995
  • 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: LAWRENCE MICHAEL KALB
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 313-424-9995