Provider Demographics
NPI:1972752889
Name:WILLIAMS, KYLE (MSW)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:GREGORY
Other - Middle Name:KYLE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18667 PINECREST LN
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1136
Mailing Address - Country:US
Mailing Address - Phone:616-402-1389
Mailing Address - Fax:
Practice Address - Street 1:17 N 4TH ST STE 211
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1267
Practice Address - Country:US
Practice Address - Phone:616-402-1389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010844811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0898189OtherBLUE CROSS BLUE SHIELD OF MICHIGAN