Tasha Bourne, LMSW
Individual provider Active NPI Clinical Social Worker · Grandville, MI
NPI 1164780888 · NPPES record last updated Jan 7, 2019
Key facts
- NPI
- 1164780888
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 6801094573 (MI)
- Practice address
- 6105 Wilson Ave SW Ste 204
Grandville, MI 49418-9714 - Phone
- (616) 486-5421
- NPI assigned
- May 1, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Clinical Social Worker | 1041C0700X | 6801094573 | MI | Yes |
Addresses
Primary practice location
6105 Wilson Ave SW Ste 204
Grandville, MI 49418-9714
Mailing address
100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560
Other providers in Grandville, MI
- Carol J Bosch
- Henry W Bosma
- Nicole Boucher
- Lisa Bouma
- Melissa R Bouma
- Daniel G Bouwens
- Jackie A Bouwman
- Mackenzie Bowling
- Hailey Anna Bowman
- Susan Ruth Branon
All providers in Grandville, MI · Clinical Social Worker in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.