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General NPI Number Information
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NPI Number | 1619794260
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Entity Type | Organization
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Legal Business Name | CONCORDIA PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 09/24/2024
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 1550 E BELTLINE AVE SE STE 350
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4399
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Country | US
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Telephone | 616-275-0705
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Fax | 616-616-5620
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Provider Business Mailing Address
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Address Line | 1550 E BELTLINE AVE SE STE 350
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4399
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Country | US
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Telephone | 616-275-0705
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Fax | 616-616-5620
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | SELINA HILL LEE
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Credential | PH.D.
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Telephone | 616-634-8958
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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 |
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License Number State |
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