Healthcare Provider Details

I. General information

NPI: 1831789536
Provider Name (Legal Business Name): GRANT CARMICHAEL MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. GRANT TOTH-CARMICHAEL

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49506-1214
US

IV. Provider business mailing address

360 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49506-1214
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-3660
  • Fax: 616-805-3631
Mailing address:
  • Phone: 616-805-3660
  • Fax: 616-805-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401019050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: