Provider Demographics
NPI:1093016917
Name:STUBBS, LYNN RICHARDS (LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:RICHARDS
Last Name:STUBBS
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3215
Mailing Address - Country:US
Mailing Address - Phone:616-546-8845
Mailing Address - Fax:
Practice Address - Street 1:222 S RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3144
Practice Address - Country:US
Practice Address - Phone:616-610-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010787811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical