DR. JOSHUA MATLACK (NPI# 1063067304) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1063067304 |
Entity Type | Individual |
Full Name | DR. JOSHUA MATLACK |
Credential | PSYD |
Practice Address |
300 68th St Se Grand Rapids MI 49548-6927 |
Practice Telephone | 2546525335 |
Enumeration Date | 2019-08-05 |
Last Update Date | 2020-11-05 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 103T00000X | Psychologist | 6301017942 | MI | Behavioral Health & Social Service Providers |
Y | 103TC0700X |
Psychologist Specialization: Clinical |
6351004338 | MI | Behavioral Health & Social Service Providers |
Street Address |
300 68TH ST SE |
City | GRAND RAPIDS |
State | MI |
Zip Code | 49548-6927 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1114920550 | Emergency Physicians Inc PC | General Practice | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2005-05-31 |
1235742768 | Robert Milton Hughes | Physician Assistant | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-08-25 |
1992317580 | Jacob Alan Lowe | Psychologist | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-08-17 |
1922619063 | Jennifer Nicole Oconnor | Social Worker | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-08-12 |
1407464670 | Christina Joy Weaver | Physician Assistant | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-07-14 |
1780200436 | Wendy Forrest | Psychiatry & Neurology | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-06-18 |
1003430877 | Cory Manoogian | Psychiatry & Neurology | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-06-08 |
1992329650 | Amy Joy Smith | Psychologist | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-05-29 |
1134743800 | Brendan Mcneilly | Psychiatry & Neurology | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-05-29 |
1467075176 | Luke Vander Wal | Psychologist | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-05-28 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1205319811 | Pooja Patel | Social Worker | Spectrum Community Services, 3353 Lousma Dr. Se, Wyoming, MI 49548 | 2018-09-10 |
1063906865 | Kimberly Eccher | Physician Assistant | 300 68th St. Se, Grand Rapids, MI 49548 | 2018-06-15 |
1871099481 | Baymark of Michigan, Inc. | Clinic/Center | 5500 Division Avenue Se, Kentwood, MI 49548 | 2018-04-03 |
1629507801 | Laura Marie Quennoz | Psychiatry & Neurology | Pine Rest Christian Mental Health Services, 300 68th Street Se, Grand Rapids, MI 49548 | 2017-06-09 |
1821548504 | Alison Anderson | Technician, Other | 103 Roth St Se, Grand Rapids, MI 49548 | 2016-10-06 |
1831540152 | Jesse Aubil | Counselor | 264 Montebello St. Se 49548, Grand Rapids, MI 49548 | 2016-06-28 |
1306237920 | Sarah Benton | Social Worker | 225 Colrain St Sw, 2, Grand Rapids, MI 49548 | 2015-02-18 |
1578996856 | Karen Marie Irving | Social Worker | 3353 Lousma Dr. Se, Wyoming, MI 49548 | 2013-08-09 |
1740348044 | Robert Kenneth Richmond | Preventive Medicine | 551 36th Street. Se, Wyoming, MI 49548 | 2006-12-05 |
1386738953 | Sharita Montiez Hall | Social Worker | 300 68th Street Se, Grand Rapids, MI 49548 | 2006-10-03 |
Find all providers in zip 49548 |
Taxonomy Code | 103TC0700X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Psychologist |
Specialization | Clinical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1427553007 | Rachel E Keelan | Psychologist | 350 Lafayette Ave Se Fl 5, Grand Rapids, MI 49503-4656 | 2018-03-27 |
1235504655 | Olivia Torres Sprauer | Psychologist | 833 Kenmoor Ave Se Ste A, Grand Rapids, MI 49546-2390 | 2015-12-10 |
1366835589 | Dr Marcia Hollingsworth, Ed.d, Pllc | Psychologist | 2025 E Beltline Ave Se Ste 102, Grand Rapids, MI 49546-7673 | 2015-03-12 |
1881945855 | John Shepherd Carton | Psychologist | 265 Wealthy St Se, Grand Rapids, MI 49503 | 2012-10-01 |
1386995900 | Jane L. Spies-wert, Ph.d., P.C. | Psychologist | 15 Ionia Ave Sw, Suite 645, Grand Rapids, MI 49503-4102 | 2012-09-21 |
1144577396 | Amy Kristine Byerley | Psychologist | 668 3 Mile Rd Nw Ste D, Grand Rapids, MI 49544-8219 | 2012-08-07 |
1326271750 | Jonathan Jay Eggerichs | Psychologist | 770 Kenmoor Ave Se Ste 101, Grand Rapids, MI 49546-8621 | 2009-09-02 |
1669604658 | Lyndsay Kate Volpe-bertram | Psychologist | 1179 East Paris Ave Se, Grand Rapids, MI 49546-8371 | 2009-08-10 |
1568609659 | Dr. Steven A. Harris, P.C. | Psychologist | 2618 East Paris, S.e. Suite B, Grand Rapids, MI 49546 | 2009-01-12 |
1255586228 | Dominic Amante | Psychologist | 29 Pearl N.w., 114 Federal Square Bldg., Grand Rapids, MI 49503 | 2008-11-18 |
Find all providers in GRAND RAPIDS |
City | GRAND RAPIDS |
Zip Code | 49548 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.