Provider Demographics
NPI:1588850465
Name:TOONSTRA PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:TOONSTRA PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:TOONSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LP
Authorized Official - Phone:218-259-7424
Mailing Address - Street 1:PO BOX 5187
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-1187
Mailing Address - Country:US
Mailing Address - Phone:218-259-7424
Mailing Address - Fax:
Practice Address - Street 1:107 SE 10TH ST
Practice Address - Street 2:UNIT 102
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3914
Practice Address - Country:US
Practice Address - Phone:218-259-7424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3523261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)