Healthcare Provider Details

I. General information

NPI: 1841912458
Provider Name (Legal Business Name): GEORGIA RUTH BAYERL LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 10/03/2023
Certification Date: 09/12/2022
Deactivation Date: 09/26/2023
Reactivation Date: 10/03/2023

III. Provider practice location address

4287 FIVE OAKS DRIVE
LANSING MI
48911
US

IV. Provider business mailing address

4287 FIVE OAKS DRIVE
LANSING MI
48911
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-4000
  • Fax:
Mailing address:
  • Phone: 517-374-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851117206
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: