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General NPI Number Information
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NPI Number | 1538437751
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Entity Type | Individual
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Provider Name | BRISHIA LEE KLUCK LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 794 PINE ST STE 230-O
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City | MUSKEGON
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State | MI
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Zip | 49442-1020
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Country | US
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Telephone | 231-375-7873
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Fax | 231-788-9162
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Provider Business Mailing Address
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Address Line | 427 SEMINOLE RD STE 200A
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City | NORTON SHORES
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State | MI
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Zip | 49444-3747
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Country | US
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Telephone | 231-375-7873
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Fax | 231-788-9162
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801093366
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License Number State | MI
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