Provider Demographics
NPI:1528117652
Name:LANIGAN, TERRY (LMSW, CFT)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:
Last Name:LANIGAN
Suffix:
Gender:F
Credentials:LMSW, CFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15530 THORNAPPLE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9109
Mailing Address - Country:US
Mailing Address - Phone:616-844-0330
Mailing Address - Fax:231-773-7299
Practice Address - Street 1:14998 CLEVELAND ST
Practice Address - Street 2:SUITE G
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-8992
Practice Address - Country:US
Practice Address - Phone:616-842-0264
Practice Address - Fax:616-842-3161
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010884401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM200734OtherHEALTHNET
NYN46011Medicare ID - Type Unspecified