Provider Demographics
NPI:1396986071
Name:GERRISH, CYNTHIA (MA LLP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:GERRISH
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 E PARIS AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6139
Mailing Address - Country:US
Mailing Address - Phone:616-975-0700
Mailing Address - Fax:616-975-7702
Practice Address - Street 1:2716 E PARIS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6139
Practice Address - Country:US
Practice Address - Phone:616-970-0700
Practice Address - Fax:616-975-7702
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007221103TC0700X
MI6161007092103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical