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NPI Code Detail

MEDICARE: PHILLIP NIENHUIS LMSW

MEDICARE:   PHILLIP  NIENHUIS  LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801087202MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205976784
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP NIENHUIS LMSW
Provider Business Mailing Address
First Line : 3424 CHICAGO DR STE 205
Second Line :
City : HUDSONVILLE
State : MI
Zip : 49426-1411
Country : US
Telephone Number : 616-426-9034
Fax Number :
Provider Business Practice Location Address
First Line : 3424 CHICAGO DR STE 205
Second Line :
City : HUDSONVILLE
State : MI
Zip : 49426-1411
Country : US
Telephone Number : 616-426-9034
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 09/03/2020

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Directions to “ PHILLIP NIENHUIS LMSW” Practice Location

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