Healthcare Provider Details

I. General information

NPI: 1295206936
Provider Name (Legal Business Name): NICK SAM BAYER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 36TH ST SE
GRAND RAPIDS MI
49512-8193
US

IV. Provider business mailing address

530 LINN ST
ALLEGAN MI
49010-1562
US

V. Phone/Fax

Practice location:
  • Phone: 616-260-3233
  • Fax:
Mailing address:
  • Phone: 269-686-8659
  • Fax: 269-686-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098368
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: