Healthcare Provider Details

I. General information

NPI: 1609416197
Provider Name (Legal Business Name): ALEXANDER SYDNEY HOUSEKNECHT PH.D., LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 WEALTHY ST SE STE 290
GRAND RAPIDS MI
49506-2755
US

IV. Provider business mailing address

337 VISSER PL SE
GRAND RAPIDS MI
49506-1541
US

V. Phone/Fax

Practice location:
  • Phone: 206-465-3302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301018243
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6352000108
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301019486
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: