1346873833 NPI number — MR. THOMAS WAYNE GRABILL LLMFT

Table of content: MR. THOMAS WAYNE GRABILL LLMFT (NPI 1346873833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346873833 NPI number — MR. THOMAS WAYNE GRABILL LLMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRABILL
Provider First Name:
THOMAS
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LLMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346873833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2585 PEBBLE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZEELAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49464-8757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-610-7454
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
388 GARDEN AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49424-8999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-222-0631
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  4101006912 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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