Provider Demographics
NPI:1720140585
Name:DRYFHOUT, LINDA M (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:DRYFHOUT
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 1:729 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-5428
Mailing Address - Country:US
Mailing Address - Phone:616-795-1648
Mailing Address - Fax:616-796-8503
Practice Address - Street 1:729 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-5428
Practice Address - Country:US
Practice Address - Phone:616-795-1648
Practice Address - Fax:616-796-8503
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086172101YA0400X, 101YM0800X, 1041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical