Provider Demographics
NPI:1194381814
Name:ESH-NAUTA, BENJAMIN (LMSW)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:ESH-NAUTA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VISSER ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2063
Mailing Address - Country:US
Mailing Address - Phone:616-502-5291
Mailing Address - Fax:
Practice Address - Street 1:1309 SHELDON RD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2404
Practice Address - Country:US
Practice Address - Phone:616-842-3600
Practice Address - Fax:616-847-5555
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099814104100000X
MI68011067741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker