Provider Demographics
NPI:1407906753
Name:BEVINGTON, JENNIFER R (LMSW, CAADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:BEVINGTON
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1529
Mailing Address - Country:US
Mailing Address - Phone:616-846-8244
Mailing Address - Fax:616-842-0886
Practice Address - Street 1:1111 FULTON ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1529
Practice Address - Country:US
Practice Address - Phone:616-846-8244
Practice Address - Fax:616-842-0886
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801088064101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1712452Medicaid
MI750910910Medicare UPIN
MI20378Medicare UPIN
MI1712452Medicaid
MI20366Medicare UPIN
MI20386Medicare UPIN
MIOP22320Medicare ID - Type Unspecified
MI20351Medicare UPIN
MI750910902Medicare UPIN
MI750910903Medicare UPIN
MI750910482Medicare UPIN