Provider Demographics
NPI:1134907454
Name:GRUTTER, ANGELA MARIE (MA, LLPC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:GRUTTER
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5777 ARROYO VISTA DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9454
Mailing Address - Country:US
Mailing Address - Phone:616-520-3364
Mailing Address - Fax:
Practice Address - Street 1:401 HALL ST SW STE 185E
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5098
Practice Address - Country:US
Practice Address - Phone:616-805-9130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional