Provider Demographics
NPI:1396017075
Name:BESEMER, MEGAN ELISE-HOLST (LMSW, CAADC)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ELISE-HOLST
Last Name:BESEMER
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:MISS
Other - First Name:MEGAN
Other - Middle Name:ELISE
Other - Last Name:HOLST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1108 LEONARD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1274
Mailing Address - Country:US
Mailing Address - Phone:161-238-0403
Mailing Address - Fax:616-459-0392
Practice Address - Street 1:1108 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1274
Practice Address - Country:US
Practice Address - Phone:161-238-0403
Practice Address - Fax:616-459-0392
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010911391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical