Provider Demographics
NPI:1477610020
Name:GREBE, JOHN K (PSYD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:GREBE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-347-5034
Mailing Address - Fax:231-347-5194
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE 208
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-347-5034
Practice Address - Fax:231-347-5194
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007160103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680B410940OtherBLUE CROSS
MI680B410940OtherBLUE CROSS
MI710996310Medicare UPIN