| River City Psychological Services Pc | |
|
1000 Monroe Ave Nw Grand Rapids MI 49503-1455 | |
| (616) 259-7207 | |
| Not Available |
| Full Name | River City Psychological Services Pc |
|---|---|
| Speciality | Psychologist |
| Location | 1000 Monroe Ave Nw, Grand Rapids, Michigan |
| Authorized Official Name and Position | Rebecca Klott (OWNER) |
| Authorized Official Contact | 6162045828 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| River City Psychological Services Pc 1000 Monroe Ave Nw Grand Rapids MI 49503-1455 Ph: (616) 259-7207 | River City Psychological Services Pc 1000 Monroe Ave Nw Grand Rapids MI 49503-1455 Ph: (616) 259-7207 |
| NPI Number | 1235557844 |
|---|---|
| Provider Enumeration Date | 04/01/2014 |
| Last Update Date | 02/26/2019 |
| Medicare PECOS PAC ID | 2769606979 |
|---|---|
| Medicare Enrollment ID | O20140610000120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235557844 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Secondary |
| Provider Name | Melissa Lidderdale |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225158306 PECOS PAC ID: 4789835398 Enrollment ID: I20121107000743 |
| Provider Name | Rebecca A Klott |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689969651 PECOS PAC ID: 9739310145 Enrollment ID: I20140328000848 |
| Provider Name | Nicole Taylor Olivas |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902318165 PECOS PAC ID: 0446656250 Enrollment ID: I20210902001003 |
| Provider Name | Miriam Goldstein |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699238121 PECOS PAC ID: 5597121889 Enrollment ID: I20230511000381 |
| Provider Name | John O Klott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194413013 PECOS PAC ID: 0143688184 Enrollment ID: I20230622002711 |
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