Healthcare Provider Details

I. General information

NPI: 1275913402
Provider Name (Legal Business Name): KATHRYN PADRON, LMSW COUNSELING AND THERAPY SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 FULTON ST E STE 114B
GRAND RAPIDS MI
49503-3200
US

IV. Provider business mailing address

233 FULTON ST E SUITE 114B
GRAND RAPIDS MI
49503-3200
US

V. Phone/Fax

Practice location:
  • Phone: 616-460-6495
  • Fax:
Mailing address:
  • Phone: 616-460-6495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090738
License Number StateMI

VIII. Authorized Official

Name: MS. KATHRYN PADRON
Title or Position: LICENSED MASTER SOCIAL WORKER
Credential: LMSW
Phone: 616-460-6495