Healthcare Provider Details

I. General information

NPI: 1942426929
Provider Name (Legal Business Name): DAVID ROBERT MACRAE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E BELTLINE AVE SE SUITE #104
GRAND RAPIDS MI
49546-7630
US

IV. Provider business mailing address

2025 E BELTLINE AVE SE SUITE #104
GRAND RAPIDS MI
49546-7630
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-3168
  • Fax: 616-957-4133
Mailing address:
  • Phone: 616-957-3168
  • Fax: 616-957-4133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number002310
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number002310
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002310
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number002310
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number002310
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number002310
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: