Provider Demographics
NPI:1992894208
Name:STARK, BETH ANNE (MSW, LMSW)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANNE
Last Name:STARK
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ANNE
Other - Last Name:ZAWADIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4000 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670-2000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 COURT ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9390
Practice Address - Country:US
Practice Address - Phone:989-345-8120
Practice Address - Fax:989-345-8129
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010783291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical