Individual
DR. MARY ELIZABETH VANDERGOOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
60 MONROE CTR NW, SUITE 8-D, GRAND RAPIDS, MI 49503-2916
(616) 957-3477
Mailing address
60 MONROE CTR NW, SUITE 8-D, GRAND RAPIDS, MI 49503-2916
(616) 957-3477
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6201002122
MI
106H00000X
Marriage & Family Therapist
4101005656
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680D14542
BLUE CROSS BLUE SHIELD
MI
Enumeration date
01/26/2006
Last updated
09/14/2011
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