Provider Demographics
NPI:1124371687
Name:VERMEULEN, MARY (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:VERMEULEN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 S GETTY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1207
Mailing Address - Country:US
Mailing Address - Phone:231-739-9315
Mailing Address - Fax:231-733-3195
Practice Address - Street 1:107 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-2015
Practice Address - Country:US
Practice Address - Phone:616-847-0207
Practice Address - Fax:231-981-5277
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010949461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical