Provider Demographics
NPI:1497963201
Name:HOUSEMAN, JIM E (CSW)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:E
Last Name:HOUSEMAN
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9021 N RODGERS CT SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7649
Mailing Address - Country:US
Mailing Address - Phone:616-891-2100
Mailing Address - Fax:
Practice Address - Street 1:1773 WOODSIDE TRL NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-2580
Practice Address - Country:US
Practice Address - Phone:616-453-1835
Practice Address - Fax:616-453-1725
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009637101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor