Courtney Lynne Kowalczyk, PHD, LLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301015496 Issued in MI

Practice address

3355 Eagle Park Dr NE Ste 109
Grand Rapids, MI 49525-7004

Phone

(616) 773-1478

Fax

(616) 773-1473

NPI assigned

Jun 16, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bright Side Psychology PLLC

  • Adolescent and Children Mental Health Clinic/Center
  • Grand Rapids, MI
  • NPI 1619749025
  NPD Authorized official
• Beurkens Autism Consulting, Inc.

  • Psychologist
  • Caledonia, MI
  • NPI 1871898338
  NPD (past)

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

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1386025344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 EAGLE PARK DR NE STE 109",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257004",
            "telephone_number": "616-773-1478",
            "fax_number": "616-773-1473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 EAGLE PARK DR NE STE 109",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257004",
            "telephone_number": "616-773-1478",
            "fax_number": "616-773-1473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWALCZYK",
        "first_name": "COURTNEY",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "PHD, LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-16",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301015496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anett Kovacs, RD
• Caitlin Kovalak
• Aleica L Kovatch, PA
• Christopher John Kowal, MA, LLC
• Conor Kowalczyk
• Katherine Ellen Kowalczyk, D.O.
• Lilly Kowalczyk
• Polly Kowalka, LBSW
• Sarah Kowalko, BSW
• Ashton Kowalski, MSOT, OTRL

• Clinical Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; 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.