Healthcare Provider Details

I. General information

NPI: 1457967044
Provider Name (Legal Business Name): LINDSEY NICOLE BEAVER LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 KENMOOR AVE SE STE C
GRAND RAPIDS MI
49546-8624
US

IV. Provider business mailing address

5925 VILLA FRANCE AVE
ANN ARBOR MI
48103-8815
US

V. Phone/Fax

Practice location:
  • Phone: 616-200-4433
  • Fax:
Mailing address:
  • Phone: 734-545-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801107706
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: