Provider Demographics
NPI:1336899426
Name:VALLIER-BOOTH, ELIZABETH JANE (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JANE
Last Name:VALLIER-BOOTH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:JANE
Other - Last Name:VALLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-0944
Mailing Address - Country:US
Mailing Address - Phone:616-550-8537
Mailing Address - Fax:
Practice Address - Street 1:103 COLLEGE AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5921
Practice Address - Country:US
Practice Address - Phone:616-229-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68510993251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical