Healthcare Provider Details

I. General information

NPI: 1598460073
Provider Name (Legal Business Name): MELISSA LUCAS-ESPINOZA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 MONROE AVE NW
GRAND RAPIDS MI
49505-4671
US

IV. Provider business mailing address

1835 BELDEN AVE SW
WYOMING MI
49509-1320
US

V. Phone/Fax

Practice location:
  • Phone: 616-323-5539
  • Fax:
Mailing address:
  • Phone: 616-323-5539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801116377
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: