Healthcare Provider Details

I. General information

NPI: 1215407044
Provider Name (Legal Business Name): WEST MICHIGAN PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 136TH AVE STE 416
HOLLAND MI
49424-2905
US

IV. Provider business mailing address

400 136TH AVE STE 416
HOLLAND MI
49424-2905
US

V. Phone/Fax

Practice location:
  • Phone: 616-952-9957
  • Fax:
Mailing address:
  • Phone: 616-952-9957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LESLIE ROBERTS
Title or Position: OWNER
Credential: LPC, LLP
Phone: 616-460-0174