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General NPI Number Information
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NPI Number | 1285140996
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Entity Type | Individual
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Provider Name | COREY ALAN METTLER MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 4829 E BELTLINE AVE NE STE 103
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9349
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Country | US
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Telephone | 616-217-8612
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Fax | 616-466-7953
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Provider Business Mailing Address
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Address Line | 4829 E BELTLINE AVE NE STE 103
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9349
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Country | US
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Telephone | 616-217-8612
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Fax | 616-466-7953
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401012945
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License Number State | MI
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