Healthcare Provider Details

I. General information

NPI: 1215200464
Provider Name (Legal Business Name): RICHARD JOHN NAVIS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PARCHMENT DR SE
GRAND RAPIDS MI
49546-3663
US

IV. Provider business mailing address

1025 ARDMORE ST SE
GRAND RAPIDS MI
49507-2710
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-9112
  • Fax: 616-957-2409
Mailing address:
  • Phone: 616-550-0794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094028
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: