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Organization
KIMBERLY B LAVENDER, LLC
Active
Organization
KIMBERLY B LAVENDER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BETH HOUPT (CREDENTIALING)
(517) 676-9788
Entity
Organization
Contact information
Practice address
309 1/2 S LAFAYETTE ST STE 202, GREENVILLE, MI 48838-1967
(616) 835-9292
Mailing address
PO BOX 10, MASON, MI 48854-0010
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
6801093841
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801093841
STATE OF MICHIGAN LICENSE
MI
Enumeration date
11/21/2014
Last updated
08/11/2022
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