Kathy A Carruthers, LMSW
Individual provider Active NPI Social Worker · Caledonia, MI
NPI 1720340367 · NPPES record last updated Mar 19, 2024
Key facts
- NPI
- 1720340367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 6801094220 (MI)
- Practice address
- 1675 84TH St SE
Caledonia, MI 49316-7939 - Phone
- (616) 238-0159
- NPI assigned
- Jun 11, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140819000218 | MI | Practitioner - Clinical Social Worker | 9032336862 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pine Rest Christian Mental Health Services | Social Worker | Current |
Accepting new patients |
| Carruthers Therapy LLC | Social Worker | Current |
Accepting new patients |
Locations
1675 84th St SE
Caledonia, MI 49316
Phone (616) 235-0159
4829 E Beltline Ave NE
Ste 303
Grand Rapids, MI 49525
Phone (616) 202-2762
300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6801094220 | MI | Yes |
Addresses
Primary practice location
1675 84TH St SE
Caledonia, MI 49316-7939
Mailing address
1125 Royal Oak St SW
Wyoming, MI 49509-3562
Other names
- Kathy A Tillottson
Other providers in Caledonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.