Provider Demographics
NPI:1134676976
Name:GRIGORYAN, VAHE
Entity Type:Individual
Prefix:
First Name:VAHE
Middle Name:
Last Name:GRIGORYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 BROOKMARK ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-6117
Mailing Address - Country:US
Mailing Address - Phone:616-914-2745
Mailing Address - Fax:
Practice Address - Street 1:1458 BROOKMARK ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-6117
Practice Address - Country:US
Practice Address - Phone:616-914-2745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician