Healthcare Provider Details

I. General information

NPI: 1497388540
Provider Name (Legal Business Name): MICHELLE LYNN HUGHES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 CELEBRATION DR NE STE 212
GRAND RAPIDS MI
49525-9200
US

IV. Provider business mailing address

10160 DUNCAN LAKE AVE SE
CALEDONIA MI
49316-9413
US

V. Phone/Fax

Practice location:
  • Phone: 616-260-3354
  • Fax:
Mailing address:
  • Phone: 616-240-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801106112
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: