Individual
KIP MICHAEL FORNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
35 MICHIGAN ST NE STE 5201, GRAND RAPIDS, MI 49503-2530
(616) 267-2830
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301019395
MI
Other
Enumeration date
12/15/2023
Last updated
12/02/2024
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