Provider Demographics
NPI:1497012975
Name:WILLIAM J. WEITZEL LMSW
Entity Type:Organization
Organization Name:WILLIAM J. WEITZEL LMSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WEITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-446-1873
Mailing Address - Street 1:3396 HIDDEN HILLS AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-9125
Mailing Address - Country:US
Mailing Address - Phone:616-446-1873
Mailing Address - Fax:
Practice Address - Street 1:4467 CASCADE RD SE
Practice Address - Street 2:SUITE 4469
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3776
Practice Address - Country:US
Practice Address - Phone:616-446-1873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010114101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty