Provider Demographics
NPI:1760697643
Name:GREER, GORDON IRWIN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:IRWIN
Last Name:GREER
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 1:1026 EDNA ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3705
Mailing Address - Country:US
Mailing Address - Phone:616-516-9251
Mailing Address - Fax:
Practice Address - Street 1:3949 SPARKS DR SE
Practice Address - Street 2:STE. 103
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6110
Practice Address - Country:US
Practice Address - Phone:616-957-5850
Practice Address - Fax:616-957-5853
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010868901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical