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General NPI Number Information
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NPI Number | 1538650981
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Entity Type | Organization
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Legal Business Name | HEATLAND PSYCHOLOGY LLC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 524 W MAIN ST
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City | IONIA
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State | MI
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Zip | 48846
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Country | US
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Telephone | 616-522-7183
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Fax | 616-523-9031
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Provider Business Mailing Address
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Address Line | 524 W MAIN ST
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City | IONIA
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State | MI
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Zip | 48846-1536
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Country | US
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Telephone | 616-523-9033
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN SMITH
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Credential |
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Telephone | 616-523-9033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301009002
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License Number State | MI
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