Provider Demographics
NPI:1720340367
Name:CARRUTHERS, KATHY A (LMSW)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:A
Last Name:CARRUTHERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:A
Other - Last Name:TILLOTTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1125 ROYAL OAK ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-3562
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1675 84TH ST SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7939
Practice Address - Country:US
Practice Address - Phone:616-238-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094220104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical