Healthcare Provider Details

I. General information

NPI: 1154751774
Provider Name (Legal Business Name): MARC GEROUX
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4894 S CENTERLINE RD
NEWAYGO MI
49337-8784
US

IV. Provider business mailing address

4894 S CENTERLINE RD
NEWAYGO MI
49337-8784
US

V. Phone/Fax

Practice location:
  • Phone: 231-349-0263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401007841
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401007841
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: