Basic Information
| Provider Information | |||||||||
| NPI: | 1841318755 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DYKSTRA | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 E OAK ST | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494121649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319246302 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12 W WOOD ST | ||||||||
| Address2: | |||||||||
| City: | NEWAYGO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316521780 | ||||||||
| FaxNumber: | 2316521786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 6301010718 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.