NPIMap

Organization Active NPI

Grand Rapids Psychology, PLLC

  • Clinical Psychologist
  • Grand Rapids, MI
National Provider Identifier
1336712561
Registry record updated Jul 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
GRAND RAPIDS PSYCHOLOGY, PLLC
Practice address
4403 Cascade Rd SE Ste 8
Grand Rapids, MI 49546-3673
Phone
(616) 915-8153
NPI assigned
Jul 24, 2021
Last updated
Jul 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2021

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

Authorized official

Name
Dr. Stacey Morgan, PSYDNPI 1275937583
Title
Psychologist
Phone
(616) 915-8153

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

4403 Cascade Rd SE Ste 8
Grand Rapids, MI 49546-3673

Mailing address

1186 Oakburn Ave SE
Grand Rapids, MI 49546-3767
Phone (616) 915-8153

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210812003419 MI Part B Supplier - Clinic/Group Practice 7810391893 Receives reassigned benefits from 1 practitioner
Practice locations: Grand Rapids, MI

National Provider Directory

National Provider Directory

Locations

4403 Cascade Rd SE
Ste 8
Grand Rapids, MI 49546
Phone (616) 915-8153

Practitioners & affiliated clinicians

Practitioners 2

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": "1627084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627084800000",
    "number": "1336712561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1186 OAKBURN AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463767",
            "telephone_number": "616-915-8153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4403 CASCADE RD SE STE 8",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463673",
            "telephone_number": "616-915-8153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND RAPIDS PSYCHOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-24",
        "last_updated": "2021-07-24",
        "certification_date": "2021-07-23",
        "status": "A",
        "authorized_official_last_name": "MORGAN",
        "authorized_official_first_name": "STACEY",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "616-915-8153",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "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 Jul 24, 2021; 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.