Provider Demographics
NPI:1043695208
Name:BURGUARD, BETH
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:BURGUARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11304 EDGEWATER DR
Mailing Address - Street 2:SUITE D.BR
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8499
Mailing Address - Country:US
Mailing Address - Phone:616-892-1070
Mailing Address - Fax:616-892-1073
Practice Address - Street 1:15360 COVE ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-9537
Practice Address - Country:US
Practice Address - Phone:616-566-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010678781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical