Healthcare Provider Details

I. General information

NPI: 1063378578
Provider Name (Legal Business Name): MASON ANTHONY HUTTER M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 EVERGREEN DR NE STE 210
GRAND RAPIDS MI
49525-9830
US

IV. Provider business mailing address

240 STRAIGHT AVE NW # 2
GRAND RAPIDS MI
49504-5675
US

V. Phone/Fax

Practice location:
  • Phone: 616-600-2845
  • Fax:
Mailing address:
  • Phone: 248-535-9736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: