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Individual

DR. JOSHUA MATLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSYD

Contact information

Practice address
4211 PARKWAY PLACE DR SW, GRANDVILLE, MI 49418-2695
(616) 222-3700
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301017942
MI
103TC0700X
Clinical Psychologist
Primary
6301018991
MI
103TC0700X
Clinical Psychologist
6351004338
MI

Other

Enumeration date
08/05/2019
Last updated
05/14/2025
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