Provider Demographics
NPI:1598222952
Name:KIMBERLEE K ERICKSON-WORPEL MA,LLP
Entity type:Organization
Organization Name:KIMBERLEE K ERICKSON-WORPEL MA,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ERICKSON-WORPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP
Authorized Official - Phone:616-560-7264
Mailing Address - Street 1:3611 HENRY STREET
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441
Mailing Address - Country:US
Mailing Address - Phone:616-560-7264
Mailing Address - Fax:231-457-4068
Practice Address - Street 1:3611 HENRY STREET
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441
Practice Address - Country:US
Practice Address - Phone:616-560-7264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty