Provider Demographics
NPI:1871625350
Name:HELMUS, LARA MARIE-DAVERMAN (LMSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:MARIE-DAVERMAN
Last Name:HELMUS
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 HERITAGE CT
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-5481
Mailing Address - Country:US
Mailing Address - Phone:616-396-6285
Mailing Address - Fax:616-355-7704
Practice Address - Street 1:607 HERITAGE CT
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-5481
Practice Address - Country:US
Practice Address - Phone:616-396-6285
Practice Address - Fax:616-355-7704
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801088594101Y00000X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker