DR. MARY ELIZABETH VANDERGOOT


Address: 60 Monroe Ctr Nw, Suite 8-d, Grand Rapids, MI 49503-2916
Phone: 6169573477

DR. MARY ELIZABETH VANDERGOOT (NPI# 1447220819) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1447220819
Entity Type Individual
Full Name DR. MARY ELIZABETH VANDERGOOT
Credential PHD
Practice Address 60 Monroe Ctr Nw
Suite 8-d
Grand Rapids
MI 49503-2916
Practice Telephone 6169573477
Mailing Telephone 6169573477
Enumeration Date 2006-01-26
Last Update Date 2011-09-14
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103T00000X Psychologist 6201002122 MI Behavioral Health & Social Service Providers
N 106H00000X Marriage & Family Therapist 4101005656 MI Behavioral Health & Social Service Providers

Other Provider Identifier

State Issuer Identifier Type Code
MI BLUE CROSS BLUE SHIELD 680D14542 01

Office Location

Street Address 60 MONROE CTR NW
SUITE 8-D
City GRAND RAPIDS
State MI
Zip Code 49503-2916

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Taxonomy Information

Taxonomy Code 103T00000X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist

Taxonomy Definition

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Notes: Source: American Psychological Association [1/1/2007: modified definition]

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1780022194 Gregory V Mallis Psychologist 1870 Leonard St Se, Grand Rapids, MI 49505-5650 2013-06-07
1821344136 Laura Ann Doughty Psychologist 800 Monroe Ave Nw Ste 206, Grand Rapids, MI 49503-1448 2012-07-24
1528321296 Mikhila N Wildey Psychologist 300 58th St Se, Grand Rapids, MI 49548-5984 2012-06-19
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Competitor

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City GRAND RAPIDS
Zip Code 49503

Improve Information

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Dataset Information

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.

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