Provider Demographics
NPI:1225020415
Name:GERSH, GENIENE MICHELLE (PHD, LPC, NCC, LLP)
Entity Type:Individual
Prefix:DR
First Name:GENIENE
Middle Name:MICHELLE
Last Name:GERSH
Suffix:
Gender:F
Credentials:PHD, LPC, NCC, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3283 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9590
Mailing Address - Country:US
Mailing Address - Phone:269-673-3384
Mailing Address - Fax:
Practice Address - Street 1:3283 122ND AVE
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9590
Practice Address - Country:US
Practice Address - Phone:269-673-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009291103TC1900X
MI6401011622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling