Individual
DR. LARRY DUGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3934 CASCADE RD SE, GRAND RAPIDS, MI 49546-2148
(616) 954-0557
(616) 954-2878
Mailing address
3934 CASCADE RD SE, GRAND RAPIDS, MI 49546-2148
(616) 954-0557
(616) 954-2878
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301 001929
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OD 145 44 7 622
BC/BS 620D145440
MI
Enumeration date
04/01/2009
Last updated
04/01/2009
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