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NPI Code Detail

MEDICARE: HRA PSYCHOLOGICAL SERVICES PC

MEDICARE: HRA PSYCHOLOGICAL SERVICES PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker
2103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1003859984
Entity Type Code : Organization
Provider Name (Legal Business Name) : HRA PSYCHOLOGICAL SERVICES PC
Provider Business Mailing Address
First Line : 2851 CHARLEVOIX DR SE STE 323
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-7092
Country : US
Telephone Number : 616-458-0692
Fax Number : 616-458-8129
Provider Business Practice Location Address
First Line : 2851 CHARLEVOIX DR SE STE 323
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-7092
Country : US
Telephone Number : 616-458-0692
Fax Number : 616-458-8129
Authorized Official
Title or Position : PRACTICE MANAGER
Name : TRACY HECKMAN
Credential : CPB
Telephone Number : 616-458-0692
Provider Enumeration Date : 06/14/2006
Last Update Date : 01/02/2025

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Directions to “HRA PSYCHOLOGICAL SERVICES PC ” Practice Location

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