Healthcare Provider Details

I. General information

NPI: 1023920790
Provider Name (Legal Business Name): GABRIELLE NICOLE BRUMMEL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 136TH AVE
HOLLAND MI
49424-7483
US

IV. Provider business mailing address

285 N 145TH AVE
HOLLAND MI
49424-6449
US

V. Phone/Fax

Practice location:
  • Phone: 616-786-2050
  • Fax:
Mailing address:
  • Phone: 248-444-9612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801094521
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: