Provider Demographics
NPI:1174858161
Name:MAXON, MARCY ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:ANN
Last Name:MAXON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S MISSION ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2763
Mailing Address - Country:US
Mailing Address - Phone:989-779-9988
Mailing Address - Fax:989-779-9955
Practice Address - Street 1:601 S MISSION ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2763
Practice Address - Country:US
Practice Address - Phone:989-779-9988
Practice Address - Fax:989-779-9955
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010866781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical