Matthew Scott Pettinga, MA, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

6401015324 Issued in MI

Practice address

3292 N Evergreen Dr NE
Grand Rapids, MI 49525-9746

Phone

(616) 365-8920

Fax

(616) 365-8971

NPI assigned

Dec 5, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759449600000",
    "number": "1124533757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3292 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-365-8920",
            "fax_number": "616-365-8971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTINGA",
        "first_name": "MATTHEW",
        "middle_name": "SCOTT",
        "credential": "MA,  LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-12-05",
        "last_updated": "2025-10-03",
        "certification_date": "2025-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401015324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Petruska
• Susanne Pettigrew, PA-C
• Erin Megan Pettijohn, M.D.
• Stuart Pettijohn, DDS
• Jayne Deur Pettinga, NURSE PRACTITIONER
• Taylor Pettit-Rademaker, LMSW, CAADC
• Kayla Lynne Pettit
• Lindsey Pettit, PA-C
• Matia Petty
• Megan Petty, MD

• Counselor in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.