Provider Demographics
NPI:1184019077
Name:COGNITIVE THERAPY OF GRAND RAPIDS
Entity Type:Organization
Organization Name:COGNITIVE THERAPY OF GRAND RAPIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:616-666-1510
Mailing Address - Street 1:3206 62ND ST
Mailing Address - Street 2:
Mailing Address - City:SAUGATUCK
Mailing Address - State:MI
Mailing Address - Zip Code:49453-9701
Mailing Address - Country:US
Mailing Address - Phone:616-666-1510
Mailing Address - Fax:
Practice Address - Street 1:3206 62ND ST
Practice Address - Street 2:
Practice Address - City:SAUGATUCK
Practice Address - State:MI
Practice Address - Zip Code:49453-9701
Practice Address - Country:US
Practice Address - Phone:616-666-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001704103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty