Healthcare Provider Details

I. General information

NPI: 1801712898
Provider Name (Legal Business Name): GRAND RAPIDS PSYCHOLOGICAL TESTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 E BELTLINE AVE SE STE 310
GRAND RAPIDS MI
49546-5937
US

IV. Provider business mailing address

2627 E BELTLINE AVE SE STE 310
GRAND RAPIDS MI
49546-5937
US

V. Phone/Fax

Practice location:
  • Phone: 616-386-5844
  • Fax: 616-317-4738
Mailing address:
  • Phone: 616-386-5844
  • Fax: 616-317-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARI COLEMAN
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 248-545-2131