Individual
MR. KURT THOMAS ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLP
Contact information
Practice address
4920 PLAINFIELD AVE NE, SUITE C, GRAND RAPIDS, MI 49525-1010
(616) 217-8612
Mailing address
4829 E BELTLINE AVE NE, STE 103, GRAND RAPIDS, MI 49525-9349
(616) 217-8612
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
6301008881
MI
103TF0000X
Family Psychologist
6301008881
MI
Other
Enumeration date
08/25/2008
Last updated
04/18/2017
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