MEDICARE: DR. KIRK L BRINK PH.D.

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	103T00000X	Psychologist	6301001773	MI

General Provider Information

NPI Number	:	1285884080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRK L BRINK PH.D.

Provider Business Mailing Address
First Line	:	983 SPAULDING AVE SE
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-3701
Country	:	US
Telephone Number	:	616-942-9000
Fax Number	:	616-942-0008

Provider Business Practice Location Address
First Line	:	983 SPAULDING AVE SE
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-3701
Country	:	US
Telephone Number	:	616-942-9000
Fax Number	:	616-942-0008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	12/14/2025

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Directions to “ DR. KIRK L BRINK PH.D.” Practice Location

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