MEDICARE: DANIEL G. ROOKS, PSY.D., P.C.

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
1	103TC0700X	Clinical Psychologist	6301008267	MI

General Provider Information

NPI Number	:	1023213279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL G. ROOKS, PSY.D., P.C.

Provider Business Mailing Address
First Line	:	3124 N WELLNESS DR
Second Line	:	SUITE 30
City	:	HOLLAND
State	:	MI
Zip	:	49424-8121
Country	:	US
Telephone Number	:	616-786-3350
Fax Number	:	616-786-3375

Provider Business Practice Location Address
First Line	:	3124 N WELLNESS DR
Second Line	:	SUITE 30
City	:	HOLLAND
State	:	MI
Zip	:	49424-8121
Country	:	US
Telephone Number	:	616-786-3350
Fax Number	:	616-786-3375

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL ROOKS
Credential	:
Telephone Number	:	616-786-3350

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	12/07/2012

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