Healthcare Provider Details

I. General information

NPI: 1083966287
Provider Name (Legal Business Name): GREGORY ANDREW WEICHHAND JR. LLP, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 E PARIS AVE SE
GRAND RAPIDS MI
49546-6139
US

IV. Provider business mailing address

54 OSWEGO ST NW
GRAND RAPIDS MI
49504-6046
US

V. Phone/Fax

Practice location:
  • Phone: 616-975-0700
  • Fax:
Mailing address:
  • Phone: 616-915-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: