Provider Demographics
NPI:1841851169
Name:CHELSEA WIERSEMA LMSW, LLC
Entity type:Organization
Organization Name:CHELSEA WIERSEMA LMSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST/ LLC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WIERSEMA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-617-6493
Mailing Address - Street 1:4240 HAVANA AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-4347
Mailing Address - Country:US
Mailing Address - Phone:616-617-6493
Mailing Address - Fax:
Practice Address - Street 1:185 44TH ST SW STE E
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-3363
Practice Address - Country:US
Practice Address - Phone:616-294-0754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty