Healthcare Provider Details

I. General information

NPI: 1669697173
Provider Name (Legal Business Name): HOLLY KATE AUSTIN-LEE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 LAKE DR SE
GRAND RAPIDS MI
49506-1674
US

IV. Provider business mailing address

1307 CALGARY ST NE
GRAND RAPIDS MI
49505-4303
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-7215
  • Fax: 616-235-0979
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088714
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: