Provider Demographics
NPI:1457707879
Name:GUS HOPSON PSYCHOLOGY AND COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:GUS HOPSON PSYCHOLOGY AND COUNSELING SERVICES LLC
Other - Org Name:GUS HOPSON PSYCHOLOGY AND COUNSELING SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LIMITED LICENSE PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GUS
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:HOPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:616-299-0284
Mailing Address - Street 1:1057ARDMORE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-2478
Mailing Address - Country:US
Mailing Address - Phone:616-299-0284
Mailing Address - Fax:616-350-9889
Practice Address - Street 1:1057 ARDMORE ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-2478
Practice Address - Country:US
Practice Address - Phone:616-299-0284
Practice Address - Fax:616-350-9889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========Medicaid