1487153938 NPI number — KAREK PSYCHOLOGICAL SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487153938 NPI number — KAREK PSYCHOLOGICAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAREK PSYCHOLOGICAL SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487153938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4467 CASCADE RD SE STE 4469
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49546-3776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-940-3331
Provider Business Mailing Address Fax Number:
616-940-1377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4467 CASCADE RD SE STE 4469
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546-3776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-940-3331
Provider Business Practice Location Address Fax Number:
616-940-1377
Provider Enumeration Date:
02/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
KAREK
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
LIMITED LICENSE PSYCHOLOGIST
Authorized Official Telephone Number:
616-940-3331

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  6301013936 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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