Individual
DR. EVAN DANIEL PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
350 LAFAYETTE AVE SE, GRAND RAPIDS, MI 49503-4656
(616) 840-8402
(616) 840-9771
Mailing address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8000
(616) 840-8224
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301006916
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437452406
—
MI
Enumeration date
12/14/2010
Last updated
01/28/2023
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