Healthcare Provider Details

I. General information

NPI: 1568177764
Provider Name (Legal Business Name): ELIZABETH JOSEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 E BELTLINE CT NE STE 100
GRAND RAPIDS MI
49525-9494
US

IV. Provider business mailing address

3280 E BELTLINE CT NE STE 100
GRAND RAPIDS MI
49525-9494
US

V. Phone/Fax

Practice location:
  • Phone: 616-213-3434
  • Fax:
Mailing address:
  • Phone: 616-213-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH JOSEY
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LMSW-C
Phone: 616-213-3434