Provider Demographics
NPI:1558600973
Name:HULST PSYCHOLOGY AND ASSESSMENT CENTER
Entity Type:Organization
Organization Name:HULST PSYCHOLOGY AND ASSESSMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HULST
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:616-901-0336
Mailing Address - Street 1:4940 CASCADE RD SE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3708
Mailing Address - Country:US
Mailing Address - Phone:616-803-0643
Mailing Address - Fax:
Practice Address - Street 1:4940 CASCADE RD SE
Practice Address - Street 2:SUITE 230
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3708
Practice Address - Country:US
Practice Address - Phone:616-803-0643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013813103T00000X
MI6301013253103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty