Individual
MRS. ELIZABETH GARY THELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW, CAADC
Contact information
Practice address
375 APPLE TREE DR, IONIA, MI 48846-7506
(616) 527-1790
Mailing address
5631 RIVERSIDE DR, LYONS, MI 48851-9792
(616) 822-4603
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801092492
MI
Other
Enumeration date
10/04/2010
Last updated
01/25/2016
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