| Kimberly B Lavender, Llc | |
|
309 1/2 S Lafayette St Ste 202 Greenville MI 48838-1967 | |
| (616) 835-9292 | |
| Not Available |
| Full Name | Kimberly B Lavender, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 309 1/2 S Lafayette St Ste 202, Greenville, Michigan |
| Authorized Official Name and Position | Mary Beth Houpt (CREDENTIALING) |
| Authorized Official Contact | 5176769788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kimberly B Lavender, Llc Po Box 10 Mason MI 48854-0010 Ph: () - | Kimberly B Lavender, Llc 309 1/2 S Lafayette St Ste 202 Greenville MI 48838-1967 Ph: (616) 835-9292 |
| NPI Number | 1548667397 |
|---|---|
| Provider Enumeration Date | 11/21/2014 |
| Last Update Date | 08/11/2022 |
| Certification Date | 08/11/2022 |
| Medicare PECOS PAC ID | 5193048833 |
|---|---|
| Medicare Enrollment ID | O20150102001378 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548667397 | NPI | - | NPPES |
| 6801093841 | Other | MI | STATE OF MICHIGAN LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | 6801093841 (Michigan) | Secondary |
| Provider Name | Harry J Fulton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053570804 PECOS PAC ID: 1850360108 Enrollment ID: I20041001001087 |
| Provider Name | Kimberly Lavender |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285985358 PECOS PAC ID: 8628149614 Enrollment ID: I20150102001251 |
| Provider Name | Brandy Murray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013466234 PECOS PAC ID: 6305124405 Enrollment ID: I20161025000352 |
| Provider Name | Tanya S Douglas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285183053 PECOS PAC ID: 6608116678 Enrollment ID: I20190329001166 |
| Provider Name | Ada M Brosier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386901163 PECOS PAC ID: 0244653418 Enrollment ID: I20200706003134 |
| Provider Name | Amanda Janeen Fisher |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063098564 PECOS PAC ID: 3870984610 Enrollment ID: I20220105000707 |
| Provider Name | Amber Mariah Reynolds |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053880179 PECOS PAC ID: 9931581352 Enrollment ID: I20220802001997 |
| Provider Name | Trudy Willadson |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1942417191 PECOS PAC ID: 9638529142 Enrollment ID: I20231226001162 |
| Provider Name | Audrey Stein-langdon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447918107 PECOS PAC ID: 1052761244 Enrollment ID: I20231229002881 |
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