Healthcare Provider Details

I. General information

NPI: 1053282970
Provider Name (Legal Business Name): GRACE BRUINS LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 64TH ST SW STE 1300
BYRON CENTER MI
49315-7975
US

IV. Provider business mailing address

2373 64TH ST SW STE 1300
BYRON CENTER MI
49315-7975
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-1350
  • Fax: 616-261-7191
Mailing address:
  • Phone: 616-685-1350
  • Fax: 616-261-7191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851119701
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: