Provider Demographics
NPI:1306996467
Name:SPOORS, DEBORAH DENISE (MA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DENISE
Last Name:SPOORS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8342 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:WEST OLIVE
Mailing Address - State:MI
Mailing Address - Zip Code:49460-9511
Mailing Address - Country:US
Mailing Address - Phone:616-638-4671
Mailing Address - Fax:616-451-3070
Practice Address - Street 1:1514 WEALTHY ST SE
Practice Address - Street 2:SUITE 260
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2755
Practice Address - Country:US
Practice Address - Phone:616-451-3008
Practice Address - Fax:616-451-3070
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007767103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist