Provider Demographics
NPI:1740338508
Name:KOHLEY, JOSEPH PATRICK (LMSW)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PATRICK
Last Name:KOHLEY
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 1:2976 IVANREST AVE SW STE 205
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1440
Mailing Address - Country:US
Mailing Address - Phone:616-261-0888
Mailing Address - Fax:616-261-3047
Practice Address - Street 1:2976 IVANREST AVE SW STE 205
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1440
Practice Address - Country:US
Practice Address - Phone:616-261-0888
Practice Address - Fax:616-261-3047
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010649561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION46450Medicare ID - Type Unspecified