Healthcare Provider Details

I. General information

NPI: 1548177199
Provider Name (Legal Business Name): THERESE JOAN MAUPIN-MOORE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 68TH ST SE
CALEDONIA MI
49316-7466
US

IV. Provider business mailing address

1831 BRIAR HILL DR
HASTINGS MI
49058-1071
US

V. Phone/Fax

Practice location:
  • Phone: 616-330-0890
  • Fax:
Mailing address:
  • Phone: 269-838-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851121417
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: