Provider Demographics
NPI:1619336070
Name:BALDUS, NANCY (LLP, LPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BALDUS
Suffix:
Gender:F
Credentials:LLP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 CHICAGO DR SW # 113
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1694
Mailing Address - Country:US
Mailing Address - Phone:616-536-1991
Mailing Address - Fax:
Practice Address - Street 1:4370 CHICAGO DR SW # 113
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1694
Practice Address - Country:US
Practice Address - Phone:616-536-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-14
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL717121101YM0800X
MIM153043103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health