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NPI Code Detail

MEDICARE: BRIDGEPOINT PSYCHOLOGICAL SERVICES LLC

MEDICARE: BRIDGEPOINT 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
1103T00000XPsychologist

General Provider Information

NPI Number : 1891626180
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIDGEPOINT PSYCHOLOGICAL SERVICES LLC
Provider Business Mailing Address
First Line : 265 KOLLEN PARK DR
Second Line :
City : HOLLAND
State : MI
Zip : 49423-3401
Country : US
Telephone Number : 616-300-4808
Fax Number : 616-300-4808
Provider Business Practice Location Address
First Line : 265 KOLLEN PARK DR
Second Line :
City : HOLLAND
State : MI
Zip : 49423-3401
Country : US
Telephone Number : 616-300-4808
Fax Number : 616-300-4808
Authorized Official
Title or Position : FOUNDER
Name : LUIS VALENCIA OSORIO
Credential : TLLP
Telephone Number : 616-300-4808
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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Directions to “BRIDGEPOINT PSYCHOLOGICAL SERVICES LLC ” Practice Location

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