Provider Demographics
NPI:1972663599
Name:TOPP, DONALD MARK (PSYD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:MARK
Last Name:TOPP
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 CASCADE RD SE
Mailing Address - Street 2:1
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3673
Mailing Address - Country:US
Mailing Address - Phone:616-975-0907
Mailing Address - Fax:616-975-3988
Practice Address - Street 1:4403 CASCADE RD SE
Practice Address - Street 2:1
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3673
Practice Address - Country:US
Practice Address - Phone:616-975-0907
Practice Address - Fax:616-975-3988
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDT009389103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD10028OtherBLUE CROSS
MIOD10028OtherBLUE CROSS