Healthcare Provider Details

I. General information

NPI: 1205171790
Provider Name (Legal Business Name): ANDREA C METTLER ARMSTRONG PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA CHRISTINE METTLER

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

IV. Provider business mailing address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-5000
  • Fax:
Mailing address:
  • Phone: 616-455-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6351004482
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004688
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810004688
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number630109246
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: