Provider Demographics
NPI:1457530982
Name:FIX, ELLEN B (LMSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:B
Last Name:FIX
Suffix:
Gender:F
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: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:616-235-2090
Mailing Address - Fax:616-235-2099
Practice Address - Street 1:500 CASCADE WEST PKWY SE
Practice Address - Street 2:STE 240
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2166
Practice Address - Country:US
Practice Address - Phone:616-591-9000
Practice Address - Fax:616-591-9060
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010681061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical