Provider Demographics
NPI:1174750459
Name:LOUWERSE, KEITH ANTHONY (PSYD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ANTHONY
Last Name:LOUWERSE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W WASHINGTON AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1074
Mailing Address - Country:US
Mailing Address - Phone:616-259-5452
Mailing Address - Fax:616-236-0875
Practice Address - Street 1:201 W WASHINGTON AVE STE 280
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1074
Practice Address - Country:US
Practice Address - Phone:616-259-5452
Practice Address - Fax:616-236-0875
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical