Healthcare Provider Details

I. General information

NPI: 1588730972
Provider Name (Legal Business Name): PATRICIA A POPE LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4304
US

IV. Provider business mailing address

680 22 MILE RD
KENT CITY MI
49330-9416
US

V. Phone/Fax

Practice location:
  • Phone: 616-356-6246
  • Fax: 616-732-6392
Mailing address:
  • Phone: 231-834-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301009851
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: