MEDICARE: NANCY BALDUS LLP, LPC

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	101YM0800X	Mental Health Counselor	L717121	MI

General Provider Information

NPI Number	:	1619336070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY BALDUS LLP, LPC

Provider Business Mailing Address
First Line	:	4370 CHICAGO DR SW # 113
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1694
Country	:	US
Telephone Number	:	616-536-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	4370 CHICAGO DR SW # 113
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1694
Country	:	US
Telephone Number	:	616-536-1991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2016
Last Update Date	:	03/19/2024

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