Provider Demographics
NPI:1922304799
Name:START AND ASSOCIATES PSYCHOLOGICAL SUPPORT, LLC
Entity Type:Organization
Organization Name:START AND ASSOCIATES PSYCHOLOGICAL SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-607-4476
Mailing Address - Street 1:320 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1289
Mailing Address - Country:US
Mailing Address - Phone:616-607-4476
Mailing Address - Fax:616-935-7177
Practice Address - Street 1:320 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1289
Practice Address - Country:US
Practice Address - Phone:616-607-4476
Practice Address - Fax:616-935-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014058251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)