Healthcare Provider Details

I. General information

NPI: 1235983099
Provider Name (Legal Business Name): LINDSEY FARLOW, LMSW L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 BATES ST SE
GRAND RAPIDS MI
49506-2615
US

IV. Provider business mailing address

825 BATES ST SE
GRAND RAPIDS MI
49506-2615
US

V. Phone/Fax

Practice location:
  • Phone: 810-623-2954
  • Fax:
Mailing address:
  • Phone: 810-623-2954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY FARLOW
Title or Position: CLINICAL SOCIAL WORKER
Credential:
Phone: 810-623-2954