Provider Demographics
NPI:1912397431
Name:CATRON, ETHAN DAVID (LMSW CAADC)
Entity Type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:DAVID
Last Name:CATRON
Suffix:
Gender:M
Credentials:LMSW CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 BUTTRICK AVE SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9223
Mailing Address - Country:US
Mailing Address - Phone:269-449-4298
Mailing Address - Fax:630-690-5282
Practice Address - Street 1:500 CASCADE WEST PKWY SE STE 240
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2166
Practice Address - Country:US
Practice Address - Phone:616-591-9000
Practice Address - Fax:616-591-9060
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2022-05-24
Deactivation Date:2022-03-21
Deactivation Code:
Reactivation Date:2022-05-20
Provider Licenses
StateLicense IDTaxonomies
MI68011081071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical