Healthcare Provider Details

I. General information

NPI: 1225020415
Provider Name (Legal Business Name): GENIENE MICHELLE GERSH PHD, LPC, NCC, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3283 122ND AVE
ALLEGAN MI
49010-9590
US

IV. Provider business mailing address

3283 122ND AVE
ALLEGAN MI
49010-9590
US

V. Phone/Fax

Practice location:
  • Phone: 269-673-3384
  • Fax:
Mailing address:
  • Phone: 269-673-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011622
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301009291
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: