Healthcare Provider Details

I. General information

NPI: 1083420665
Provider Name (Legal Business Name): MERCY RIVER COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N JEFFERSON ST STE 7
MARSHALL MI
49068-1553
US

IV. Provider business mailing address

111 N JEFFERSON ST STE 7
MARSHALL MI
49068-1553
US

V. Phone/Fax

Practice location:
  • Phone: 269-986-3045
  • Fax:
Mailing address:
  • Phone: 269-986-3045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SUSAN FOX
Title or Position: COUNSELOR
Credential:
Phone: 269-986-3045