Healthcare Provider Details

I. General information

NPI: 1396902961
Provider Name (Legal Business Name): MARILYN RUTH-COOMBS MCLANE L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 BELLE CHASE WAY
LANSING MI
48911
US

IV. Provider business mailing address

3475 BELLE CHASE WAY
LANSING MI
48911
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax: 517-882-3633
Mailing address:
  • Phone: 517-882-3732
  • Fax: 517-882-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801083840
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: