Provider Demographics
NPI:1174130850
Name:RECLAIM PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:RECLAIM PSYCHOLOGICAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:616-520-8046
Mailing Address - Street 1:3100 IVANREST AVE SW STE 102
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1488
Mailing Address - Country:US
Mailing Address - Phone:616-520-8046
Mailing Address - Fax:616-600-9554
Practice Address - Street 1:3100 IVANREST AVE SW STE 102
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1488
Practice Address - Country:US
Practice Address - Phone:616-520-8046
Practice Address - Fax:616-600-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty