Provider Demographics
NPI:1932320363
Name:NAUTA, STEPHEN JAY (LMSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JAY
Last Name:NAUTA
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 1:107 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-2015
Mailing Address - Country:US
Mailing Address - Phone:616-847-0207
Mailing Address - Fax:616-296-9217
Practice Address - Street 1:107 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-2015
Practice Address - Country:US
Practice Address - Phone:616-847-0207
Practice Address - Fax:616-296-9217
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010864631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7000075971OtherPRIORITY HEALTH ID
MI0P09480Medicare PIN