=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740454420
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOPP PSYCHOLOGICAL SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2008
-----------------------------------------------------
Last Update Date | 04/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4403 CASCADE RD SE STE 1
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-3673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-975-0907
-----------------------------------------------------
Fax | 616-975-3988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4403 CASCADE RD SE STE 1
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49546-3673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-975-0907
-----------------------------------------------------
Fax | 616-975-3988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DONALD MARK TOPP
-----------------------------------------------------
Credential | PSY.D
-----------------------------------------------------
Telephone | 616-975-0907
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | DT009389
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------