Provider Demographics
NPI:1750601431
Name:CYR, ELIZABETH A (PSYD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:CYR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:300 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4211 PARKWAY PL SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2695
Practice Address - Country:US
Practice Address - Phone:616-222-3700
Practice Address - Fax:616-222-3707
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015032103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID16189127Medicare PIN