Healthcare Provider Details

I. General information

NPI: 1841480134
Provider Name (Legal Business Name): PSYCHIATRIC ASSOCIATES OF WEST MICHIGAN, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 HERON BAY DR
SAUGATUCK MI
49453-9687
US

IV. Provider business mailing address

PO BOX 140241
GRAND RAPIDS MI
49514-0241
US

V. Phone/Fax

Practice location:
  • Phone: 616-719-4488
  • Fax: 616-719-4480
Mailing address:
  • Phone: 616-735-1505
  • Fax: 616-675-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VALERIE ALEXANDER
Title or Position: MANAGER
Credential:
Phone: 616-735-1505