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General NPI Number Information
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NPI Number | 1932974128
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Entity Type | Organization
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Legal Business Name | LISA WILLIAMS BRATSBURG, LMSW, LLC
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 800 MONROE AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1445
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Country | US
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Telephone | 616-802-8732
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Fax |
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Provider Business Mailing Address
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Address Line | 3075 BEECHFOREST ST
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City | HUDSONVILLE
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State | MI
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Zip | 49426-1710
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Country | US
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Telephone | 616-802-8732
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | LISA BRATSBURG
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Credential | LMSW
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Telephone | 616-802-8732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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