Adolescent And Family Behavioral Health Services
Psychologist in Grand Rapids, MI. Organization (NPI-2).
NPI number1184054652
StatusActive
Last updated in NPPESFeb 9, 2019
Details
- NPI
- 1184054652
- Entity type
- Organization (NPI-2)
- Legal business name
- Adolescent And Family Behavioral Health Services
- Organization subpart
- No
- Enumeration date
- Nov 20, 2013
- Last updated
- Feb 9, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103T00000X | Psychologist | 6301015520 | MI | Yes |
Practice location
3501 Lake Eastbrook Blvd Se#258
Grand Rapids, MI 49546-5938
Phone 616-719-0194 · Fax 800-219-5205
Mailing address
2566 Woodmeadow Dr SeGrand Rapids, MI 49546-8031
Phone 616-719-0194 · Fax 800-219-5205
Authorized official
Valencia Agnew
Psychologist
6167190194
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