Healthcare Provider Details

I. General information

NPI: 1598204737
Provider Name (Legal Business Name): MAUREEN ANN DOROUGH MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 N BRIDGE ST
SARANAC MI
48881-5102
US

IV. Provider business mailing address

415 BRIDGE ST NW APT 308
GRAND RAPIDS MI
49504-4390
US

V. Phone/Fax

Practice location:
  • Phone: 616-642-6466
  • Fax: 616-642-6621
Mailing address:
  • Phone: 616-460-3564
  • Fax: 616-642-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401005036
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberL746901
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401005036
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: