Lakeshore Integrative Mental Health Services, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

LAKESHORE INTEGRATIVE MENTAL HEALTH SERVICES, LLC

Practice address

800 E Ellis Rd
Mail Box 577, Suite 271
Norton Shores, MI 49441-5646

Phone

(231) 799-4850

Fax

(231) 799-4851

NPI assigned

Mar 27, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Diane Lynn Bruursema, LMSW, ACSWNPI 1487762175

Title

Owner/Clinical Social Worker

Phone

(231) 799-4850

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Diane Bruursema, LMSW

  • Clinical Social Worker
  • Holland, MI
  • NPI 1487762175
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427414400000",
    "number": "1447644471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E ELLIS RD",
            "address_2": "MAIL BOX 577, SUITE 271",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494415646",
            "telephone_number": "231-799-4850",
            "fax_number": "231-799-4851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E ELLIS RD",
            "address_2": "MAIL BOX 577, SUITE 271",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494415646",
            "telephone_number": "231-799-4850",
            "fax_number": "231-799-4851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE INTEGRATIVE MENTAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-27",
        "last_updated": "2015-03-27",
        "status": "A",
        "authorized_official_last_name": "BRUURSEMA",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER/CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "231-799-4850",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMSW, ACSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lafayette Women'S Health PLC
• Lake Michigan Family Dental, PLLC
• Lakes OBGYN Specialist
• Lakeshore Concierge Medicine PLLC
• Lakeshore Derm & Laser Center PLC
• Lakeshore Professional Eyecare PC
• Laketown Family Dental, PLLC
• Ivan R Landan, M.D.
• Rachael Nicole Lane, DO
• Marissa F Lange

• Clinical Social Worker in Norton Shores, MI
• Providers in Norton Shores, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.