Healthcare Provider Details

I. General information

NPI: 1316907462
Provider Name (Legal Business Name): BETHEL D REIMEL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 GREENWOOD SE
GRAND RAPIDS MI
49506
US

IV. Provider business mailing address

2057 43RD STREET SE R-04 R-04
GRAND RAPIDS MI
49508
US

V. Phone/Fax

Practice location:
  • Phone: 616-551-3884
  • Fax: 616-551-3884
Mailing address:
  • Phone: 616-551-3884
  • Fax: 616-551-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801001172
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8601001172
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: