Provider Demographics
NPI:1578674602
Name:ALDERINK, LARRY JAMES (MA LLP)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:JAMES
Last Name:ALDERINK
Suffix:
Gender:M
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13961 148TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417
Mailing Address - Country:US
Mailing Address - Phone:616-842-3179
Mailing Address - Fax:231-737-1218
Practice Address - Street 1:3370 GLADE ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-2778
Practice Address - Country:US
Practice Address - Phone:231-737-1213
Practice Address - Fax:231-737-1218
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPI08975940OtherBLUE CARE NETWORK
MI5688680OtherFIRST HEALTH