=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184547184
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARISSA MCNAMARA-TERRY MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2026
-----------------------------------------------------
Last Update Date | 08/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2B S WASHINGTON ST
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48371-4971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-834-0614
-----------------------------------------------------
Fax | 248-487-9377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9263 VILLA CREST DR
-----------------------------------------------------
City | CLARKSTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48346-1864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-834-0614
-----------------------------------------------------
Fax | 248-487-9377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6451025207
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------