Healthcare Provider Details

I. General information

NPI: 1497222608
Provider Name (Legal Business Name): GRANT THOMAS BUHR LICSW, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 04/08/2023
Certification Date: 04/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 BRISTOL AVE NW
GRAND RAPIDS MI
49504
US

IV. Provider business mailing address

1115 BALL AVE NE
GRAND RAPIDS MI
49505
US

V. Phone/Fax

Practice location:
  • Phone: 616-485-7155
  • Fax:
Mailing address:
  • Phone: 206-397-5619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC60893202
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61139524
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114133
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: