Provider Demographics
NPI:1366316093
Name:BARBOT, GRAYSON (NBC-HWC; ACSM-CEP)
Entity type:Individual
Prefix:
First Name:GRAYSON
Middle Name:
Last Name:BARBOT
Suffix:
Gender:M
Credentials:NBC-HWC; ACSM-CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 COURTNEY ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-2910
Mailing Address - Country:US
Mailing Address - Phone:231-408-7021
Mailing Address - Fax:
Practice Address - Street 1:1218 COURTNEY ST NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-2910
Practice Address - Country:US
Practice Address - Phone:231-408-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-04
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIA-4055599171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach