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General NPI Number Information
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NPI Number | 1558600973
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Entity Type | Organization
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Legal Business Name | HULST PSYCHOLOGY AND ASSESSMENT CENTER
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 4940 CASCADE RD SE SUITE 230
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3708
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Country | US
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Telephone | 616-803-0643
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Fax |
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Provider Business Mailing Address
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Address Line | 4940 CASCADE RD SE SUITE 230
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3708
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Country | US
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Telephone | 616-803-0643
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MRS. SUSIE HULST
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Credential | MA
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Telephone | 616-901-0336
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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 | 6301013253
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301013813
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License Number State | MI
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