Provider Demographics
NPI:1275821886
Name:MURRAY, BETHANY ANNE (LMSW, CAAC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANNE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:LMSW, CAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 MYRTLE ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-3009
Mailing Address - Country:US
Mailing Address - Phone:616-459-7389
Mailing Address - Fax:
Practice Address - Street 1:4175 3 MILE RD NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49534-1133
Practice Address - Country:US
Practice Address - Phone:616-453-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-17
Last Update Date:2011-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010891031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical