Provider Demographics
NPI:1356328009
Name:GRIB, JOHN A (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:GRIB
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 JASPER ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2853
Mailing Address - Country:US
Mailing Address - Phone:269-382-0515
Mailing Address - Fax:269-382-3189
Practice Address - Street 1:918 JASPER ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2853
Practice Address - Country:US
Practice Address - Phone:269-382-0515
Practice Address - Fax:269-382-3189
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801060417104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC9104010Medicare ID - Type UnspecifiedPARTICIPATING PROVIDER