Healthcare Provider Details

I. General information

NPI: 1750948220
Provider Name (Legal Business Name): ANCHORED FAMILY PSYCHOLOGY AND COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7086 8TH AVE
JENISON MI
49428-9352
US

IV. Provider business mailing address

7086 8TH AVE
JENISON MI
49428-9352
US

V. Phone/Fax

Practice location:
  • Phone: 616-667-9551
  • Fax:
Mailing address:
  • Phone: 616-667-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC J DYKSTRA
Title or Position: OWNER/LICENSED PSYCHOLOGIST
Credential: PSY.D
Phone: 616-667-9551