Provider Demographics
NPI:1053657064
Name:RICH, MARLENE (LLPC)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:RICH
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 1:300 W FERRY ST
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1109
Mailing Address - Country:US
Mailing Address - Phone:269-815-5331
Mailing Address - Fax:269-815-5061
Practice Address - Street 1:300 W FERRY ST
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1109
Practice Address - Country:US
Practice Address - Phone:269-815-5331
Practice Address - Fax:269-815-5061
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional