Healthcare Provider Details

I. General information

NPI: 1720853146
Provider Name (Legal Business Name): NURTUREHER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 N RIVER RD
FORT GRATIOT MI
48059-4230
US

IV. Provider business mailing address

3451 N RIVER RD
FORT GRATIOT MI
48059-4230
US

V. Phone/Fax

Practice location:
  • Phone: 810-300-9619
  • Fax:
Mailing address:
  • Phone: 810-300-9619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KELLY BAKER
Title or Position: OWNER/THERAPIST
Credential: LMSW, PMH-C
Phone: 810-300-9619