Provider Demographics
NPI:1609975622
Name:GRONDIN, MAURICE (LMSW LMFT CAADC)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:GRONDIN
Suffix:
Gender:M
Credentials:LMSW LMFT CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E BELTLINE AVE SE
Mailing Address - Street 2:STE 105
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4361
Mailing Address - Country:US
Mailing Address - Phone:616-322-0705
Mailing Address - Fax:616-233-3229
Practice Address - Street 1:1500 E BELTLINE AVE SE
Practice Address - Street 2:STE 105
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4361
Practice Address - Country:US
Practice Address - Phone:616-322-0705
Practice Address - Fax:616-233-3229
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801012524104100000X
MI4101005798106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOD16262016Medicare ID - Type Unspecified