Provider Demographics
NPI:1871166595
Name:STRICKLEN PSYCHOLOGY LLC
Entity type:Organization
Organization Name:STRICKLEN PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:STRICKLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:616-401-6578
Mailing Address - Street 1:833 KENMOOR AVE SE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2390
Mailing Address - Country:US
Mailing Address - Phone:616-401-6578
Mailing Address - Fax:616-965-3968
Practice Address - Street 1:833 KENMOOR AVE SE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2390
Practice Address - Country:US
Practice Address - Phone:616-551-4690
Practice Address - Fax:616-965-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health