Basic Information
| Provider Information | |||||||||
| NPI: | 1184255879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COVEY | ||||||||
| FirstName: | KARSON | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LLMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VISSCHER | ||||||||
| OtherFirstName: | KARSON | ||||||||
| OtherMiddleName: | RAE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9085 CHAMPLAIN PL | ||||||||
| Address2: | |||||||||
| City: | WEST OLIVE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494609058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317362572 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2201 S GETTY ST | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494441207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317399315 | ||||||||
| FaxNumber: | 2317337380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2020 | ||||||||
| LastUpdateDate: | 06/29/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801106877 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.