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General NPI Number Information
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NPI Number | 1750616892
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Entity Type | Organization
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Legal Business Name | MERRELL RECOVERY ASSOCIATES PLLC
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Dates
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Enumeration Date | 10/07/2009
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 41 WASHINGTON AVE SUITE 368
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City | GRAND HAVEN
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State | MI
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Zip | 49417-1390
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Country | US
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Telephone | 616-844-7003
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Fax | 616-844-7003
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Provider Business Mailing Address
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Address Line | PO BOX 841
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City | GRAND HAVEN
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State | MI
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Zip | 49417-0841
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Country | US
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Telephone | 616-844-7003
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Fax | 616-844-7003
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH MERRELL III
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Credential | ACSW
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Telephone | 616-844-7003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6801016149
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License Number State | MI
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