Organization
139 EDUCATION, LLC.
Active
Other names
Neurocore
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY ROYER PSY (PROVIDER/AUTHORIZED OFFICIAL)
(800) 600-4096
Entity
Organization
Contact information
Practice address
3148 44TH ST SW, GRANDVILLE, MI 49418
(800) 600-4096
(800) 606-8839
Mailing address
201 MONROE AVE NW, SUITE 300, GRAND RAPIDS, MI 49503
(800) 600-4096
(800) 606-8839
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301009353
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D14689
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
11/10/2011
Last updated
02/21/2017
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