Healthcare Provider Details

I. General information

NPI: 1871166595
Provider Name (Legal Business Name): STRICKLEN PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 KENMOOR AVE SE STE A
GRAND RAPIDS MI
49546-2390
US

IV. Provider business mailing address

833 KENMOOR AVE SE STE A
GRAND RAPIDS MI
49546-2390
US

V. Phone/Fax

Practice location:
  • Phone: 616-551-4690
  • Fax: 616-965-3968
Mailing address:
  • Phone: 616-401-6578
  • Fax: 616-965-3968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JORDAN DANIEL STRICKLEN
Title or Position: OWNER
Credential: PSYD
Phone: 616-401-6578