Healthcare Provider Details

I. General information

NPI: 1841860616
Provider Name (Legal Business Name): MERRILL GRAHAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E BELTLINE AVE SE STE 340
GRAND RAPIDS MI
49506-4362
US

IV. Provider business mailing address

3037 RIVERWOODS DR NE
ROCKFORD MI
49341-9290
US

V. Phone/Fax

Practice location:
  • Phone: 616-210-3888
  • Fax:
Mailing address:
  • Phone: 616-914-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. MERRILL GRAHAM
Title or Position: CLINICIAN
Credential: PHD, LMSW
Phone: 616-210-3888