GREAT LAKES PSYCHIATRIC SERVICES P.C. NPI 1275653115

NPI Information

GREAT LAKES PSYCHIATRIC SERVICES, P.C. is an adult mental health clinic center in Grand Rapids, MI. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. GREAT LAKES PSYCHIATRIC SERVICES, P.C. NPI is 1275653115. The provider is registered as an organization entity type.

The provider's business location address is:

1179 E PARIS AVE SE
SUITE 220
GRAND RAPIDS, MI
ZIP 49546-371
Phone: (616) 454-2004
Fax: (616) 454-0061

The provider's authorized official is David Dirk Vander Velde .
The authorized official title is President and has the following contact phone number (616) 454-2004.

The enumeration date for this NPI number is 3/31/2007 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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