=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730897430
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETSIE OPAL LITTLE LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2022
-----------------------------------------------------
Last Update Date | 05/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4084 OKEMOS RD STE A
-----------------------------------------------------
City | OKEMOS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48864-3258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-772-1987
-----------------------------------------------------
Fax | 517-879-4889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 917 CLYDE ST
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48915-2007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-690-5258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------