Healthcare Provider Details

I. General information

NPI: 1003859984
Provider Name (Legal Business Name): HRA PSYCHOLOGICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 CHARLEVOIX DR SE STE 323
GRAND RAPIDS MI
49546-7092
US

IV. Provider business mailing address

2851 CHARLEVOIX DR SE STE 323
GRAND RAPIDS MI
49546-7092
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-0692
  • Fax: 616-458-8129
Mailing address:
  • Phone: 616-458-0692
  • Fax: 616-458-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TRACY HECKMAN
Title or Position: PRACTICE MANAGER
Credential: CPB
Phone: 616-458-0692