Organization
GREAT LAKES PSYCHIATRIC SERVICES, P.C.
Active
Organization
GREAT LAKES PSYCHIATRIC SERVICES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID DIRK VANDER VELDE D.O. (PRESIDENT)
(616) 454-2004
Entity
Organization
Contact information
Practice address
1179 E PARIS AVE SE, SUITE 220, GRAND RAPIDS, MI 49546-8371
(616) 454-2004
(616) 454-0061
Mailing address
1179 E PARIS AVE SE, SUITE 220, GRAND RAPIDS, MI 49546-8371
(616) 454-2004
(616) 454-0061
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
5101009000
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26OD111150
BLUE CROSS BLUE SHIELD
MI
Enumeration date
03/31/2007
Last updated
08/22/2020
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