Provider Demographics
NPI:1760787998
Name:ROCKFORD PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:ROCKFORD PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JON
Authorized Official - Last Name:BIRKELAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:616-866-4830
Mailing Address - Street 1:16 NORTH MONROE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341
Mailing Address - Country:US
Mailing Address - Phone:616-866-4830
Mailing Address - Fax:616-866-4944
Practice Address - Street 1:16 NORTH MONROE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341
Practice Address - Country:US
Practice Address - Phone:616-866-4830
Practice Address - Fax:616-866-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006087103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty