Provider Demographics
NPI:1588264808
Name:HAULENBEEK, JANUARY (LMSW-CLINICAL)
Entity type:Individual
Prefix:
First Name:JANUARY
Middle Name:
Last Name:HAULENBEEK
Suffix:
Gender:F
Credentials:LMSW-CLINICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10093 W P AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-4405
Mailing Address - Country:US
Mailing Address - Phone:269-760-5670
Mailing Address - Fax:
Practice Address - Street 1:10093 W P AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-4405
Practice Address - Country:US
Practice Address - Phone:269-760-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011081881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical