Healthcare Provider Details

I. General information

NPI: 1043451677
Provider Name (Legal Business Name): BARBARA BEERTHUIS, LMSW, LCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 44TH ST SE #C44
GRAND RAPIDS MI
49512-4138
US

IV. Provider business mailing address

4460 44TH ST SE #C44
GRAND RAPIDS MI
49512-4138
US

V. Phone/Fax

Practice location:
  • Phone: 616-916-9978
  • Fax: 612-637-1704
Mailing address:
  • Phone: 616-916-9978
  • Fax: 612-637-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801033459
License Number StateMI

VIII. Authorized Official

Name: MS. BARBARA ELLENS BEERTHUIS
Title or Position: OWNER
Credential: LMSW
Phone: 616-916-9978