Individual
RENEE L VANDER MYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LLP
Contact information
Practice address
1444 MICHIGAN ST NE STE 8, GRAND RAPIDS, MI 49503-2028
(616) 631-7760
Mailing address
1444 MICHIGAN ST NE STE 8, GRAND RAPIDS, MI 49503-2028
(616) 631-7760
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301011876
MI
103TA0700X
Adult Development & Aging Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
6301011876
MI
103TC0700X
Clinical Psychologist
6301011876
MI
103TC2200X
Clinical Child & Adolescent Psychologist
6301011876
MI
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TF0000X
Family Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
6301011876
MI
106H00000X
Marriage & Family Therapist
6301011876
MI
Other
Enumeration date
09/28/2007
Last updated
11/06/2019
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