Healthcare Provider Details

I. General information

NPI: 1134053861
Provider Name (Legal Business Name): LA ROSA PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
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:
Mailing address:
  • Phone: 616-681-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KAMILLE LA ROSA
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 616-681-3955