Provider Demographics
NPI:1710430277
Name:MEHRETU-HARMENIL, NEESHAN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:NEESHAN
Middle Name:
Last Name:MEHRETU-HARMENIL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:NEESHAN
Other - Middle Name:
Other - Last Name:MEHRETU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4572 S HAGADORN RD STE 3C
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5385
Practice Address - Country:US
Practice Address - Phone:517-896-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YM0800X
MI6801100155104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health