Provider Demographics
NPI:1760551121
Name:VANDEN HEUVEL, JEREME PAUL (LMSW)
Entity Type:Individual
Prefix:
First Name:JEREME
Middle Name:PAUL
Last Name:VANDEN HEUVEL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3287 DEEP ROSE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8838
Mailing Address - Country:US
Mailing Address - Phone:616-277-6419
Mailing Address - Fax:
Practice Address - Street 1:3287 DEEP ROSE DR
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-8838
Practice Address - Country:US
Practice Address - Phone:616-277-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085477104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker