Healthcare Provider Details

I. General information

NPI: 1649460601
Provider Name (Legal Business Name): WILLIAM JOSEPH EYRE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 GULL RD
KALAMAZOO MI
49048-1611
US

IV. Provider business mailing address

80 W 24TH ST
HOLLAND MI
49423-4775
US

V. Phone/Fax

Practice location:
  • Phone: 616-381-9800
  • Fax:
Mailing address:
  • Phone: 616-394-0853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801014191
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: