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NPI Code Detail

MEDICARE: WEST MICHIGAN PSYCHOLOGICAL SERVICES LLC

MEDICARE: WEST MICHIGAN PSYCHOLOGICAL SERVICES LLC
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
1103TC1900XCounseling Psychologist
2103T00000XPsychologist
3101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1215407044
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST MICHIGAN PSYCHOLOGICAL SERVICES LLC
Provider Business Mailing Address
First Line : 400 136TH AVE STE 416
Second Line :
City : HOLLAND
State : MI
Zip : 49424-2905
Country : US
Telephone Number : 616-952-9957
Fax Number :
Provider Business Practice Location Address
First Line : 400 136TH AVE STE 416
Second Line :
City : HOLLAND
State : MI
Zip : 49424-2905
Country : US
Telephone Number : 616-952-9957
Fax Number :
Authorized Official
Title or Position : OWNER
Name : LESLIE ROBERTS
Credential : LPC, LLP
Telephone Number : 616-460-0174
Provider Enumeration Date : 12/05/2018
Last Update Date : 10/03/2025

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Directions to “WEST MICHIGAN PSYCHOLOGICAL SERVICES LLC ” Practice Location

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