NPIMap

Organization Active NPI

Hope & Wholeness Psychology Center, LLC

  • Clinical Psychologist
  • Holland, MI
National Provider Identifier
1841726809
Registry record updated Aug 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301016570 Issued in MI
Legal business name
HOPE & WHOLENESS PSYCHOLOGY CENTER, LLC
Practice address
340 104TH Ave
Holland, MI 49423-9149
Phone
(616) 795-0298
NPI assigned
May 11, 2017
Last updated
Aug 3, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2017

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

Authorized official

Name
Dr. Ryan A Duckworth, PSYDNPI 1740680883
Title
Clinical Psychologist
Phone
(616) 795-0298

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
Clinical Psychologist 103TC0700X 6301016570 MI Primary

Addresses

Primary practice location

340 104TH Ave
Holland, MI 49423-9149

Mailing address

1058 Vos St
Jenison, MI 49428-8105
Phone (616) 795-0298

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170705001775 MI Part B Supplier - Clinic/Group Practice 6901175082 Receives reassigned benefits from 32 practitioners
Practice locations: Jenison, MI; Muskegon, MI; Holland, MI

National Provider Directory

National Provider Directory

Locations

340 104th Ave
Holland, MI 49423
Phone (616) 795-0298

348 S Waverly Rd
Ste 201
Holland, MI 49423
Phone (616) 795-0298

503 Century Ln
Ste 2
Holland, MI 49423
Phone (616) 295-8284

1881 Georgetown Center Dr
Jenison, MI 49428
Phone (616) 795-0298

794 Pine St
Ste 220G
Muskegon, MI 49442
Phone (616) 795-0298

Practitioners & affiliated clinicians

Practitioners 35

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 35

NPI Registry JSON

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501718400000",
    "number": "1841726809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1058 VOS ST",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "494288105",
            "telephone_number": "616-795-0298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 104TH AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494239149",
            "telephone_number": "616-795-0298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOPE & WHOLENESS PSYCHOLOGY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-08-03",
        "status": "A",
        "authorized_official_last_name": "DUCKWORTH",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "616-795-0298",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301016570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2017; 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.