Provider Demographics
NPI:1467443903
Name:DURISEK, MARION (M ED, LPC)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:DURISEK
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 HALL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5711
Mailing Address - Country:US
Mailing Address - Phone:586-419-3423
Mailing Address - Fax:586-997-4956
Practice Address - Street 1:11111 HALL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5711
Practice Address - Country:US
Practice Address - Phone:586-419-3423
Practice Address - Fax:586-997-4956
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401221246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional