Healthcare Provider Details

I. General information

NPI: 1134273766
Provider Name (Legal Business Name): HEALTH PSYCHOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 S. 9TH STREET
KALAMAZOO MI
49009
US

IV. Provider business mailing address

P.O. BOX 263
OSHTEMO MI
49077-0263
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-0624
  • Fax: 269-375-0008
Mailing address:
  • Phone: 269-375-0624
  • Fax: 269-375-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301001976
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801065401
License Number StateMI

VIII. Authorized Official

Name: PATRICIA R. WILLIAMS
Title or Position: VICE PRESIDENT
Credential: LMSW
Phone: 269-375-0624