Provider Demographics
NPI:1508394875
Name:HELMHOLDT, MEAGAN (LMSW)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:HELMHOLDT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:
Other - Last Name:GREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6051 FRANKFORT HWY
Mailing Address - Street 2:
Mailing Address - City:BENZONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49616-9558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6051 FRANKFORT HWY
Practice Address - Street 2:
Practice Address - City:BENZONIA
Practice Address - State:MI
Practice Address - Zip Code:49616-9558
Practice Address - Country:US
Practice Address - Phone:877-398-2013
Practice Address - Fax:231-882-2195
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801101474104100000X
MI6802089541104100000X
MI6801105566104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6802089541OtherLIMITED LICENSE BACHELOR'S LICENSE
MI6801101474OtherLIMITED LICENSE MASTER'S LICENSE
MI6801105566OtherLICENSE MASTER'S LICENSE