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General NPI Number Information
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NPI Number | 1154507325
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Entity Type | Organization
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Legal Business Name | DAVID R MACRAE, PH.D., P.C.
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Dates
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Enumeration Date | 01/17/2008
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 2025 E BELTLINE AVE SE STE 104
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7673
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Country | US
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Telephone | 616-957-3168
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Fax | 616-957-4033
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Provider Business Mailing Address
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Address Line | 2025 E BELTLINE AVE SE STE 104
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7673
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Country | US
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Telephone | 616-957-3168
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Fax | 616-957-4033
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Authorized Official
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Title or Position | OWNER
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Name | DAVID R MACRAE
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Credential | PH.D.
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Telephone | 616-957-3168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 002310
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License Number State | MI
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