Basic Information
| Provider Information | |||||||||
| NPI: | 1750948220 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANCHORED FAMILY PSYCHOLOGY AND COUNSELING ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4570 EQUESTRIAN DR | ||||||||
| Address2: | |||||||||
| City: | HUDSONVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494267492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163087722 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7086 8TH AVE | ||||||||
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| City: | JENISON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494289352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166679551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | DYKSTRA | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/LICENSED PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 6163087722 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TM1800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities | 103TC0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.