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General NPI Number Information
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NPI Number | 1356691158
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Entity Type | Individual
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Provider Name | GRANT MATTHEW HELLER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 3888 NILES RD
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-8612
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Country | US
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Telephone | 269-428-0222
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Fax | 269-428-7456
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Provider Business Mailing Address
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Address Line | 100 MICHIGAN ST NE # MC845
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2560
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Country | US
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Telephone |
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301015232
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301015232
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License Number State | MI
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