Provider Demographics
NPI:1417113408
Name:PIERCE, BLYTH N (LMSW)
Entity type:Individual
Prefix:MRS
First Name:BLYTH
Middle Name:N
Last Name:PIERCE
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 1:2020 CROZIER AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1430
Mailing Address - Country:US
Mailing Address - Phone:231-759-7235
Mailing Address - Fax:
Practice Address - Street 1:125 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5041
Practice Address - Country:US
Practice Address - Phone:231-724-3699
Practice Address - Fax:231-724-3659
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010165731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical