Healthcare Provider Details

I. General information

NPI: 1578399366
Provider Name (Legal Business Name): KATRINA BASEL MA, TMLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 KOLLEN PARK DR
HOLLAND MI
49423-3401
US

IV. Provider business mailing address

265 KOLLEN PARK DR
HOLLAND MI
49423-3401
US

V. Phone/Fax

Practice location:
  • Phone: 616-681-3955
  • Fax: 616-681-3958
Mailing address:
  • Phone: 616-681-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: