Provider Demographics
NPI:1497576581
Name:WAGENVELD, BRITTNEY LEE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:BRITTNEY
Middle Name:LEE
Last Name:WAGENVELD
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 1:10235 SUMMERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-2239
Mailing Address - Country:US
Mailing Address - Phone:616-298-5858
Mailing Address - Fax:
Practice Address - Street 1:7740 BYRON CENTER AVE SW STE 102
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-6929
Practice Address - Country:US
Practice Address - Phone:616-366-5813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011160521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical