Provider Demographics
NPI:1689232027
Name:GR FAMILY THERAPY PLLC
Entity Type:Organization
Organization Name:GR FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRANDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LLMFT
Authorized Official - Phone:616-438-3861
Mailing Address - Street 1:1900 UNION AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-2660
Mailing Address - Country:US
Mailing Address - Phone:616-438-3861
Mailing Address - Fax:
Practice Address - Street 1:401 HALL ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-1845
Practice Address - Country:US
Practice Address - Phone:616-438-3861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)