MEDICARE: LKH THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1023760527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LKH THERAPY LLC

Provider Business Mailing Address
First Line	:	2918 CHICAGO DRIVE
Second Line	:
City	:	GRANVILLE
State	:	MI
Zip	:	49418
Country	:	US
Telephone Number	:	616-284-8152
Fax Number	:

Provider Business Practice Location Address
First Line	:	2918 CHICAGO DRIVE
Second Line	:
City	:	GRANVILLE
State	:	MI
Zip	:	49418
Country	:	US
Telephone Number	:	616-284-8152
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLE NUTT
Credential	:	LMSW
Telephone Number	:	616-284-8152

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	01/25/2022

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Directions to “LKH THERAPY LLC ” Practice Location

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