Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date: 09/26/2023
Reactivation Date: 10/03/2023

III. Provider practice location address

2200 COMMONS PKWY
OKEMOS MI
48864-3988
US

IV. Provider business mailing address

2200 COMMONS PKWY
OKEMOS MI
48864-3988
US

V. Phone/Fax

Practice location:
  • Phone: 616-755-8572
  • Fax:
Mailing address:
  • Phone: 616-755-8572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121864
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: