Healthcare Provider Details

I. General information

NPI: 1750942694
Provider Name (Legal Business Name): MICAH AARON BELL LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 KALAMAZOO AVE SE
GRAND RAPIDS MI
49507-4004
US

IV. Provider business mailing address

2010 KALAMAZOO AVE SE
GRAND RAPIDS MI
49507-4004
US

V. Phone/Fax

Practice location:
  • Phone: 616-893-9782
  • Fax:
Mailing address:
  • Phone: 616-893-9782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092526
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: