Provider Demographics
NPI:1538437751
Name:KLUCK, BRISHIA LEE (LMSW)
Entity type:Individual
Prefix:
First Name:BRISHIA
Middle Name:LEE
Last Name:KLUCK
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 1:427 SEMINOLE RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3747
Mailing Address - Country:US
Mailing Address - Phone:231-375-7873
Mailing Address - Fax:231-788-9162
Practice Address - Street 1:794 PINE ST STE 230-O
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-1020
Practice Address - Country:US
Practice Address - Phone:231-375-7873
Practice Address - Fax:231-788-9162
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010933661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical