Provider Demographics
NPI:1033546189
Name:USSERY, MONIKA (LLPC)
Entity Type:Individual
Prefix:MRS
First Name:MONIKA
Middle Name:
Last Name:USSERY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 E PARIS AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2907
Mailing Address - Country:US
Mailing Address - Phone:616-437-8145
Mailing Address - Fax:
Practice Address - Street 1:2025 S WASHINGTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0828
Practice Address - Country:US
Practice Address - Phone:517-371-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI46-3298198Medicaid