Healthcare Provider Details

I. General information

NPI: 1205403581
Provider Name (Legal Business Name): MARISSA LYNN BURTON L.L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARISSA KOSTICK L.L.M.S.W.

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 S EUCLID AVE
BAY CITY MI
48706-3311
US

IV. Provider business mailing address

1217 S EUCLID AVE
BAY CITY MI
48706-3311
US

V. Phone/Fax

Practice location:
  • Phone: 989-667-9661
  • Fax:
Mailing address:
  • Phone: 989-667-9661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118243
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802091123
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: