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General NPI Number Information
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NPI Number | 1972041648
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Entity Type | Organization
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Legal Business Name | PROSPICARE PLLC
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 1409 CHEROKEE ST
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City | KALAMAZOO
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State | MI
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Zip | 49006-2015
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Country | US
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Telephone | 269-352-7922
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Fax |
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Provider Business Mailing Address
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Address Line | 1409 CHEROKEE ST
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City | KALAMAZOO
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State | MI
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Zip | 49006-2015
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Country | US
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Telephone | 269-352-7922
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MARY BETH HOUPT
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Credential |
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Telephone | 517-676-9788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301016014
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License Number State | MI
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