Healthcare Provider Details

I. General information

NPI: 1619648920
Provider Name (Legal Business Name): NICHOLE LYNN PRIOR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 MICHIGAN ST NE FL 3
GRAND RAPIDS MI
49503-5609
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-447-5820
  • Fax:
Mailing address:
  • Phone: 616-486-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801107763
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: