Organization
139 EDUCATION, LLC
Active
Other names
Neurocore
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY ROYER (OWNER)
(616) 706-5649
Entity
Organization
Contact information
Practice address
1971 E BELTLINE AVE NE, SUITE 212, GRAND RAPIDS, MI 49525-7045
(800) 600-4096
Mailing address
3790 30TH ST SW, GRANDVILLE, MI 49418-1602
(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
01
—
1013294628
NPI #
MI
Enumeration date
02/15/2012
Last updated
02/15/2012
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