Individual
ERIC WILLMARTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
4100 LAKE DR SE, STE 305, GRAND RAPIDS, MI 49546
(616) 285-1377
(616) 285-1006
Mailing address
61 COMMERCE AVE SW, GRAND RAPIDS, MI 49503-4124
(616) 940-0660
(616) 940-1965
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301002796
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041493
VALUE OPTIONS
—
01
—
0998829
HEALTH PLAN OF MI
MI
01
—
680D146790
BLUE CROSS BLUE SHIELD
MI
Enumeration date
09/14/2006
Last updated
11/19/2008
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