Provider Demographics
NPI:1619023389
Name:HOVESTADT, ALAN JAMES (EDD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAMES
Last Name:HOVESTADT
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4191 SQUIRE HEATH RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4060
Mailing Address - Country:US
Mailing Address - Phone:269-492-2988
Mailing Address - Fax:
Practice Address - Street 1:1179 E PARIS AVE SE
Practice Address - Street 2:SUITE 220
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8371
Practice Address - Country:US
Practice Address - Phone:269-492-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001817101YP2500X
MI4101006021106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist