Healthcare Provider Details

I. General information

NPI: 1932563111
Provider Name (Legal Business Name): MEGHAN LYTLE-BURROWS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 SUBURBAN SHORES DR NE
GRAND RAPIDS MI
49525-1841
US

IV. Provider business mailing address

3501 LAKE EASTBROOK BLVD SE STE 120
GRAND RAPIDS MI
49546-5939
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-3460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801090607
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801090607
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090607
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: