NPIMap

Organization Active NPI

Adolescent and Family Behavioral Health Services

  • Psychologist
  • Grand Rapids, MI
National Provider Identifier
1184054652
Registry record updated Feb 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301015520 Issued in MI
Legal business name
ADOLESCENT AND FAMILY BEHAVIORAL HEALTH SERVICES
Practice address
3501 Lake Eastbrook Blvd SE
#258
Grand Rapids, MI 49546-5938
Phone
(616) 719-0194
Fax
(800) 219-5205
NPI assigned
Nov 20, 2013
Last updated
Feb 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Valencia Agnew, PHDNPI 1851473839
Title
Psychologist
Phone
(616) 719-0194

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X 6301015520 MI Primary

Addresses

Primary practice location

3501 Lake Eastbrook Blvd SE
#258
Grand Rapids, MI 49546-5938

Mailing address

2566 Woodmeadow Dr SE
Grand Rapids, MI 49546-8031
Phone (616) 719-0194

National Provider Directory

National Provider Directory

Locations

3501 Lake Eastbrook Blvd SE
Ste 258
Grand Rapids, MI 49546
Phone (616) 295-7614

55 Harrow Ln
Saginaw, MI 48638
Phone (616) 855-4523

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549670400000",
    "number": "1184054652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2566 WOODMEADOW DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468031",
            "telephone_number": "616-719-0194",
            "fax_number": "800-219-5205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 LAKE EASTBROOK BLVD SE",
            "address_2": "#258",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465938",
            "telephone_number": "616-719-0194",
            "fax_number": "800-219-5205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADOLESCENT AND FAMILY BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-20",
        "last_updated": "2019-02-09",
        "status": "A",
        "authorized_official_last_name": "AGNEW",
        "authorized_official_first_name": "VALENCIA",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "616-719-0194",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301015520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.