Healthcare Provider Details

I. General information

NPI: 1528117652
Provider Name (Legal Business Name): TERRY LANIGAN LMSW, CFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14998 CLEVELAND ST SUITE G
SPRING LAKE MI
49456-8992
US

IV. Provider business mailing address

15530 THORNAPPLE DR
GRAND HAVEN MI
49417-9109
US

V. Phone/Fax

Practice location:
  • Phone: 616-842-0264
  • Fax: 616-842-3161
Mailing address:
  • Phone: 616-844-0330
  • Fax: 231-773-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801088440
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200734
Identifier TypeOTHER
Identifier StateNM
Identifier IssuerHEALTHNET

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: