Healthcare Provider Details

I. General information

NPI: 1609684877
Provider Name (Legal Business Name): TIERRA SHEETS LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 BURTON ST SE # 210
GRAND RAPIDS MI
49506-4669
US

IV. Provider business mailing address

4181 MICHAEL AVE SW
WYOMING MI
49509-4328
US

V. Phone/Fax

Practice location:
  • Phone: 616-482-9807
  • Fax:
Mailing address:
  • Phone: 616-482-9807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851117805
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: