Healthcare Provider Details

I. General information

NPI: 1619749025
Provider Name (Legal Business Name): BRIGHT SIDE PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 EAGLE PARK DR NE STE 109
GRAND RAPIDS MI
49525-7004
US

IV. Provider business mailing address

3355 EAGLE PARK DR NE STE 109
GRAND RAPIDS MI
49525-7004
US

V. Phone/Fax

Practice location:
  • Phone: 616-773-1478
  • Fax: 616-773-1473
Mailing address:
  • Phone: 616-773-1478
  • Fax: 616-773-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. COURTNEY LYNNE KOWALCZYK
Title or Position: OWNER
Credential: PHD
Phone: 616-773-1478