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5340 Holiday Ter Kalamazoo MI 49009-2196 | |
| (269) 372-4140 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist - Counseling |
| Location | 5340 Holiday Ter, Kalamazoo, Michigan |
| Authorized Official Name and Position | Nicole Mcgruder (PRACTICE MANAGER) |
| Authorized Official Contact | 2693724140 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5340 Holiday Ter Kalamazoo MI 49009-2196 Ph: (269) 372-4140 | 5340 Holiday Ter Kalamazoo MI 49009-2196 Ph: (269) 372-4140 |
| NPI Number | 1366710774 |
|---|---|
| Provider Enumeration Date | 12/13/2011 |
| Last Update Date | 04/08/2021 |
| Certification Date | 04/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366710774 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | 6301008415 (Michigan) | Primary |
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