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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