| Randall Wolthuis, Ph.d. Llc | |
|
8202 Triple L Trl Se Alto MI 49302-9551 | |
| (616) 275-2113 | |
| Not Available |
| Full Name | Randall Wolthuis, Ph.d. Llc |
|---|---|
| Speciality | Psychologist |
| Location | 8202 Triple L Trl Se, Alto, Michigan |
| Authorized Official Name and Position | Randall Lee Wolthuis (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 6162752113 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Randall Wolthuis, Ph.d. Llc 8202 Triple L Trl Se Alto MI 49302-9551 Ph: (616) 250-2217 | Randall Wolthuis, Ph.d. Llc 8202 Triple L Trl Se Alto MI 49302-9551 Ph: (616) 275-2113 |
| NPI Number | 1174160550 |
|---|---|
| Provider Enumeration Date | 12/05/2019 |
| Last Update Date | 03/21/2024 |
| Certification Date | 03/21/2024 |
| Medicare PECOS PAC ID | 0345676383 |
|---|---|
| Medicare Enrollment ID | O20200211000338 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174160550 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Randall Lee Wolthuis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639390743 PECOS PAC ID: 2365488509 Enrollment ID: I20050628001231 |
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