| Great Lakes Psychiatric Services, P.c. | |
|
1179 E Paris Ave Se Suite 220 Grand Rapids MI 49546-8371 | |
| (616) 454-2004 | |
| (616) 454-0061 |
| Full Name | Great Lakes Psychiatric Services, P.c. |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 1179 E Paris Ave Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | David Dirk Vander Velde (PRESIDENT) |
| Authorized Official Contact | 6164542004 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Psychiatric Services, P.c. 1179 E Paris Ave Se Suite 220 Grand Rapids MI 49546-8371 Ph: (616) 454-2004 | Great Lakes Psychiatric Services, P.c. 1179 E Paris Ave Se Suite 220 Grand Rapids MI 49546-8371 Ph: (616) 454-2004 |
| NPI Number | 1275653115 |
|---|---|
| Provider Enumeration Date | 03/31/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275653115 | NPI | - | NPPES |
| 26OD111150 | Other | MI | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 5101009000 (Michigan) | Primary |
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