Healthcare Provider Details

I. General information

NPI: 1689044406
Provider Name (Legal Business Name): PATRICIA LAUREN BERTHELOT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 HARRISON ST
GRAND LEDGE MI
48837-1577
US

IV. Provider business mailing address

8448 VALLEY RD NW
RAPID CITY MI
49676-9516
US

V. Phone/Fax

Practice location:
  • Phone: 517-338-3090
  • Fax:
Mailing address:
  • Phone: 231-944-0384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098702
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: