Healthcare Provider Details

I. General information

NPI: 1285140996
Provider Name (Legal Business Name): COREY ALAN METTLER MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 E BELTLINE AVE NE STE 103
GRAND RAPIDS MI
49525-9349
US

IV. Provider business mailing address

4829 E BELTLINE AVE NE STE 103
GRAND RAPIDS MI
49525-9349
US

V. Phone/Fax

Practice location:
  • Phone: 616-217-8612
  • Fax: 616-466-7953
Mailing address:
  • Phone: 616-217-8612
  • Fax: 616-466-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012945
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: