Provider Demographics
NPI:1194823906
Name:GARLICK, CAREY ELIZABETH (LMSW)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:ELIZABETH
Last Name:GARLICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:ELIZABETH
Other - Last Name:PEABODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:300 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6927
Mailing Address - Country:US
Mailing Address - Phone:616-455-5000
Mailing Address - Fax:
Practice Address - Street 1:1700 E BELTLINE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7044
Practice Address - Country:US
Practice Address - Phone:616-364-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801062706104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ35287Medicare UPIN
MID16222125Medicare ID - Type UnspecifiedMEDICARE