Provider Demographics
NPI:1508248873
Name:NUISMER, SCOTT (MA, LPC, CAADC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:NUISMER
Suffix:
Gender:M
Credentials:MA, LPC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 E 8TH ST
Mailing Address - Street 2:#230
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3575
Mailing Address - Country:US
Mailing Address - Phone:616-422-7787
Mailing Address - Fax:
Practice Address - Street 1:44 E 8TH ST
Practice Address - Street 2:#230
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3575
Practice Address - Country:US
Practice Address - Phone:616-422-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015796101YP2500X
MIC-03253101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)