Healthcare Provider Details

I. General information

NPI: 1184547184
Provider Name (Legal Business Name): MARISSA MCNAMARA-TERRY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2B S WASHINGTON ST
OXFORD MI
48371-4971
US

IV. Provider business mailing address

9263 VILLA CREST DR
CLARKSTON MI
48346-1864
US

V. Phone/Fax

Practice location:
  • Phone: 248-834-0614
  • Fax: 248-487-9377
Mailing address:
  • Phone: 248-834-0614
  • Fax: 248-487-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025207
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: