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General NPI Number Information
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NPI Number | 1770753899
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Entity Type | Organization
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Legal Business Name | MADRID PSYCHOLOGICAL ASSOCIATES
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 4467 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-4808
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Country | US
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Telephone | 616-534-5445
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Fax | 616-534-5536
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Provider Business Mailing Address
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Address Line | 4467 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-4808
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Country | US
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Telephone | 616-534-5445
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Fax | 616-534-5536
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Authorized Official
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Title or Position | CHIEF ASSOCIATE/PRESIDENT
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Name | DR. RAUL P. MADRID
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Credential | PSY. D.
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Telephone | 616-534-5445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6301007493
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License Number State | MI
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