Healthcare Provider Details

I. General information

NPI: 1932599453
Provider Name (Legal Business Name): HOLLY BATHRICK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 PLYMOUTH AVE NE STE B
GRAND RAPIDS MI
49505
US

IV. Provider business mailing address

911 PEACHCREST CT NE
GRAND RAPIDS MI
49505-6434
US

V. Phone/Fax

Practice location:
  • Phone: 616-439-0079
  • Fax:
Mailing address:
  • Phone: 616-439-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089694
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: