Provider Demographics
NPI:1780975268
Name:MYRKLE, KATHY A (LMSW)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:MYRKLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:A
Other - Last Name:BRESLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2100 RAYBROOK ST SE STE 203
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5783
Mailing Address - Country:US
Mailing Address - Phone:616-956-9440
Mailing Address - Fax:616-954-1520
Practice Address - Street 1:2100 RAYBROOK ST SE STE 203
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5783
Practice Address - Country:US
Practice Address - Phone:616-956-9440
Practice Address - Fax:616-954-1520
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085782104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker