Provider Demographics
NPI:1689733438
Name:KURTH, NICHOLE DANELLE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:DANELLE
Last Name:KURTH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:DANELLE
Other - Last Name:KOSTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3356 COLLINGWOOD AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-3219
Mailing Address - Country:US
Mailing Address - Phone:616-532-4113
Mailing Address - Fax:
Practice Address - Street 1:12265 JAMES ST
Practice Address - Street 2:BUILDING A-1
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8613
Practice Address - Country:US
Practice Address - Phone:616-392-1873
Practice Address - Fax:616-393-5687
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085589104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker