Provider Demographics
NPI:1316907462
Name:REIMEL, BETHEL D (LMSW)
Entity type:Individual
Prefix:
First Name:BETHEL
Middle Name:D
Last Name:REIMEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2057 43RD STREET SE R-04
Mailing Address - Street 2:R-04
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508
Mailing Address - Country:US
Mailing Address - Phone:616-551-3884
Mailing Address - Fax:616-551-3884
Practice Address - Street 1:529 GREENWOOD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506
Practice Address - Country:US
Practice Address - Phone:616-551-3884
Practice Address - Fax:616-551-3884
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010011721041C0700X
MI8601001172104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0896835OtherBCBSM
MIM13301Medicare PIN