Provider Demographics
NPI:1043530850
Name:PLUNKETT, DARRYL P (PHD)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:P
Last Name:PLUNKETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 WILDFLOWER LN SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-5391
Mailing Address - Country:US
Mailing Address - Phone:616-803-0569
Mailing Address - Fax:
Practice Address - Street 1:4649 N BRETON CT SE STE A
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-5222
Practice Address - Country:US
Practice Address - Phone:616-275-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009586101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional