Doctor Name: | MR. GREGORY WORTLEY |
NPI Number: | 1053740357 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 6801083252 |
Business Practice Address: | 2280 E Grand River Ave Howell, MI - 488438503 |
Business Phone Number: | 5175464126 |
Business Fax Number: | 5175461300 |
Mailing Address: | 622 E Grand River Ave, HOWELL |
State: | MI |
Postal Code: | 488432329 |
Phone Number: | 5175480081 |
Fax Number: | 5175480498 |
NPI Enumeration Date: | 11/06/2013 |
NPI Last Update Date: | 11/06/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801083252 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |