Provider Demographics
NPI:1508974726
Name:GEOGHAN, MICHAEL KEVIN (RN, LMSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KEVIN
Last Name:GEOGHAN
Suffix:
Gender:M
Credentials:RN, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1881 ORA ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-1621
Mailing Address - Country:US
Mailing Address - Phone:231-689-7330
Mailing Address - Fax:231-689-7345
Practice Address - Street 1:1049 E NEWELL ST
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-8795
Practice Address - Country:US
Practice Address - Phone:231-689-7330
Practice Address - Fax:231-689-7345
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010599771041C0700X
MI4704110516163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered163WA2000XNursing Service ProvidersRegistered NurseAdministrator