Provider Demographics
NPI:1033383591
Name:CK PSYCHOLOGICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:CK PSYCHOLOGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:616-494-0808
Mailing Address - Street 1:246 S RIVER AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3253
Mailing Address - Country:US
Mailing Address - Phone:616-494-0808
Mailing Address - Fax:616-494-0011
Practice Address - Street 1:246 S RIVER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3253
Practice Address - Country:US
Practice Address - Phone:616-494-0808
Practice Address - Fax:616-494-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty