Provider Demographics
NPI:1598870362
Name:ELBERT, KAREN MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:ELBERT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 WHIMBREL CT NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-7156
Mailing Address - Country:US
Mailing Address - Phone:616-930-3874
Mailing Address - Fax:616-930-3875
Practice Address - Street 1:967 SPAULDING AVE SE STE D
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-3703
Practice Address - Country:US
Practice Address - Phone:616-930-3874
Practice Address - Fax:616-930-3875
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801078716104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0896804OtherBC/BS
MI0896804OtherBC/BS
MIMI8118Medicare PIN
MI0896804OtherBC/BS