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General NPI Number Information
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NPI Number | 1902255284
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Entity Type | Individual
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Provider Name | ALEXIS TERPSTRA BCBA, PSY.S
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Gender | Female
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 2930 KNAPP ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-4518
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Country | US
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Telephone | 616-558-2885
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 MASON ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1331
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Country | US
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Telephone | 616-558-2885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BACB354690
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | SP0000001061481
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License Number State | MI
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