Healthcare Provider Details

I. General information

NPI: 1811291990
Provider Name (Legal Business Name): ALPHA PSYCHOLOGICAL SERVICES OF WESTERN MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 OAK AVE
MUSKEGON MI
49442-2408
US

IV. Provider business mailing address

1804 OAK AVE
MUSKEGON MI
49442-2408
US

V. Phone/Fax

Practice location:
  • Phone: 231-773-8093
  • Fax: 231-773-8952
Mailing address:
  • Phone: 231-773-8093
  • Fax: 231-773-8952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6301006533
License Number StateMI

VIII. Authorized Official

Name: DR. ALLAN WARREN CRUMMETT
Title or Position: LICENSED PSYCHOLOGIST
Credential: ED.D.
Phone: 231-773-8093