NPIMap

Adolescent and Family Behavioral Health Services

Organization Active NPI Psychologist · Grand Rapids, MI

NPI 1184054652 · NPPES record last updated Feb 9, 2019

Key facts

NPI
1184054652
Entity type
Organization (NPI type 2)
Primary specialty
Psychologist 103T00000X
License
6301015520 (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
Organization subpart
No

Authorized official

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

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

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Locations

3501 Lake Eastbrook Blvd SE
Ste 258
Grand Rapids, MI 49546
Phone (616) 719-0194

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 103T00000X 6301015520 MI Yes

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 9, 2019.

{
    "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

All providers in Grand Rapids, MI · Psychologist in Michigan

Sources for this page

Verify at the official NPI Registry.