Provider Demographics
NPI:1528353778
Name:BEHAVIORAL RESOURCES AND INSTITUTE FOR NEUROPSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:BEHAVIORAL RESOURCES AND INSTITUTE FOR NEUROPSYCHOLOGICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:616-365-8920
Mailing Address - Street 1:3292 EVERGREEN DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9580
Mailing Address - Country:US
Mailing Address - Phone:616-365-8920
Mailing Address - Fax:616-365-8971
Practice Address - Street 1:3292 EVERGREEN DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9580
Practice Address - Country:US
Practice Address - Phone:616-365-8920
Practice Address - Fax:616-365-8971
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL RESOURCES AND INSTITUTE FOR NEUROPSYCHOLOGICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-16
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012443103G00000X
MI68010676791041C0700X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty