Healthcare Provider Details

I. General information

NPI: 1881945855
Provider Name (Legal Business Name): JOHN SHEPHERD CARTON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 WEALTHY ST SE
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

265 WEALTHY ST SE
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-840-8000
  • Fax:
Mailing address:
  • Phone: 616-840-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2307
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: