Healthcare Provider Details

I. General information

NPI: 1689837965
Provider Name (Legal Business Name): GABRIEL M GRIFFIN M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 CELEBRATION DR NE STE 212
GRAND RAPIDS MI
49525-9200
US

IV. Provider business mailing address

2090 CELEBRATION DR NE STE 212
GRAND RAPIDS MI
49525-9200
US

V. Phone/Fax

Practice location:
  • Phone: 616-915-1686
  • Fax:
Mailing address:
  • Phone: 616-915-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301010777
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: