Provider Demographics
NPI:1841318755
Name:DYKSTRA, JOYCE MARIE (LLP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:MARIE
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1649
Mailing Address - Country:US
Mailing Address - Phone:231-924-6302
Mailing Address - Fax:
Practice Address - Street 1:12 W WOOD ST
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337
Practice Address - Country:US
Practice Address - Phone:231-652-1780
Practice Address - Fax:231-652-1786
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010718103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling