Individual
DR. BRENT MICHAEL ELLENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
720 E 8TH ST STE 2, HOLLAND, MI 49423-3079
(616) 355-0549
(616) 355-0480
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301011810
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P101976540
BC/BS
MI
Enumeration date
06/21/2006
Last updated
01/07/2022
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