Healthcare Provider Details

I. General information

NPI: 1396114567
Provider Name (Legal Business Name): PAULA LETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6117 CHARLEVOIX WOODS CT SE
GRAND RAPIDS MI
49546-8505
US

IV. Provider business mailing address

900 NE 18TH AVE 1207
FORT LAUDERDALE FL
33304-3063
US

V. Phone/Fax

Practice location:
  • Phone: 855-241-7160
  • Fax: 954-324-8354
Mailing address:
  • Phone: 855-241-7160
  • Fax: 954-324-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088913
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: