Provider Demographics
NPI:1134273766
Name:HEALTH PSYCHOLOGY PC
Entity type:Organization
Organization Name:HEALTH PSYCHOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-375-0624
Mailing Address - Street 1:P.O. BOX 263
Mailing Address - Street 2:
Mailing Address - City:OSHTEMO
Mailing Address - State:MI
Mailing Address - Zip Code:49077-0263
Mailing Address - Country:US
Mailing Address - Phone:269-375-0624
Mailing Address - Fax:269-375-0008
Practice Address - Street 1:3335 S. 9TH STREET
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009
Practice Address - Country:US
Practice Address - Phone:269-375-0624
Practice Address - Fax:269-375-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801065401104100000X
MI6301001976103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008902000OtherBLUE CROSS
MI680C945110OtherBLUE CROSS
MI0C96082Medicare PIN