Healthcare Provider Details

I. General information

NPI: 1265179659
Provider Name (Legal Business Name): NATASHA JAINA BERNAL BUHL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATASHA JAINA AGUIRRE BERNAL

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 EAGLE CREST DR NE STE 100
GRAND RAPIDS MI
49525-7005
US

IV. Provider business mailing address

3215 EAGLE CREST DR NE STE 100
GRAND RAPIDS MI
49525-7005
US

V. Phone/Fax

Practice location:
  • Phone: 616-209-8745
  • Fax:
Mailing address:
  • Phone: 616-209-8357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119352
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: