Healthcare Provider Details

I. General information

NPI: 1033417480
Provider Name (Legal Business Name): CARRIE ANN PAPPAS MA,LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 KENMOOR AVE SE STE 303
GRAND RAPIDS MI
49546-8622
US

IV. Provider business mailing address

6006 ARROYO VISTA DR NE
ROCKFORD MI
49341-9400
US

V. Phone/Fax

Practice location:
  • Phone: 616-625-9066
  • Fax: 616-369-5782
Mailing address:
  • Phone: 616-625-9066
  • Fax: 616-451-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6361002939
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301012126
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: