Provider Demographics
NPI:1912193749
Name:WESTRATE, MARK EDWIN (LMSW, CAADC, BCD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:EDWIN
Last Name:WESTRATE
Suffix:
Gender:M
Credentials:LMSW, CAADC, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1767
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-1767
Mailing Address - Country:US
Mailing Address - Phone:616-396-6285
Mailing Address - Fax:616-396-6285
Practice Address - Street 1:607 HERITAGE CT
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-5481
Practice Address - Country:US
Practice Address - Phone:616-396-6285
Practice Address - Fax:616-396-6285
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010694721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical