Healthcare Provider Details

I. General information

NPI: 1265860258
Provider Name (Legal Business Name): MARIA G. GRUPPEN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301015704
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: