NPIMap

Organization Active NPI

River City Psychological Services PC

  • Clinical Psychologist
  • Grand Rapids, MI
National Provider Identifier
1235557844
Registry record updated Feb 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
RIVER CITY PSYCHOLOGICAL SERVICES PC
Practice address
1000 Monroe Ave NW
Grand Rapids, MI 49503-1455
Phone
(616) 259-7207
NPI assigned
Apr 1, 2014
Last updated
Feb 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

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

Authorized official

Name
Dr. Rebecca Klott, PHDNPI 1689969651
Title
Owner
Phone
(616) 204-5828

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X Primary
Counseling Psychologist 103TC1900X

Addresses

Primary practice location

1000 Monroe Ave NW
Grand Rapids, MI 49503-1455

Mailing address

1000 Monroe Ave NW
Grand Rapids, MI 49503-1455
Phone (616) 259-7207

Other practice location 1

233 Fulton St E Ste 526
Grand Rapids, MI 49503-3200
Phone (616) 259-7207

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140610000120 MI Part B Supplier - Clinic/Group Practice 2769606979 Receives reassigned benefits from 10 practitioners
Practice locations: Grand Rapids, MI

National Provider Directory

National Provider Directory

Locations

1000 Monroe Ave NW
Grand Rapids, MI 49503
Phone (616) 259-7207

233 Fulton St E
Ste 524526
Grand Rapids, MI 49503
Phone (616) 259-7207

233 Fulton St E
Ste 526
Grand Rapids, MI 49503
Phone 6168053660 ext. 1142

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1396310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739836800000",
    "number": "1235557844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MONROE AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031455",
            "telephone_number": "616-259-7207",
            "fax_number": "616-259-7261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MONROE AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031455",
            "telephone_number": "616-259-7207"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "233 Fulton St E Ste 526",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495033200",
            "country_code": "US",
            "telephone_number": "616-259-7207",
            "fax_number": "616-259-7261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RIVER CITY PSYCHOLOGICAL SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-01",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A",
        "authorized_official_last_name": "KLOTT",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-204-5828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.