Healthcare Provider Details

I. General information

NPI: 1366227886
Provider Name (Legal Business Name): KATHLEEN VAN PELT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 MEGUZEE PT
ELK RAPIDS MI
49629-9551
US

IV. Provider business mailing address

220 W GARFIELD AVE
CHARLEVOIX MI
49720-1631
US

V. Phone/Fax

Practice location:
  • Phone: 231-264-8108
  • Fax:
Mailing address:
  • Phone: 800-432-4121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851117207
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: