Healthcare Provider Details

I. General information

NPI: 1790469096
Provider Name (Legal Business Name): AUTHENTIC CONNECTION PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 RAYBROOK ST SE STE 201-B
GRAND RAPIDS MI
49546-7739
US

IV. Provider business mailing address

2040 RAYBROOK ST SE STE 201-B
GRAND RAPIDS MI
49546-7739
US

V. Phone/Fax

Practice location:
  • Phone: 616-320-4689
  • Fax:
Mailing address:
  • Phone: 616-320-4689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY SHERD
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 616-970-1407