Provider Demographics
NPI:1235625369
Name:MERSHA-SCARLETT, HIRUT (SOCIAL WORKER)
Entity Type:Individual
Prefix:MRS
First Name:HIRUT
Middle Name:
Last Name:MERSHA-SCARLETT
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 23068
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-3068
Mailing Address - Country:US
Mailing Address - Phone:517-267-1270
Mailing Address - Fax:
Practice Address - Street 1:4084 OKEMOS RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3258
Practice Address - Country:US
Practice Address - Phone:517-347-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-01
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087035104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker