Provider Demographics
NPI:1568872091
Name:MCNITT, MYRNA (CSW)
Entity Type:Individual
Prefix:PROF
First Name:MYRNA
Middle Name:
Last Name:MCNITT
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-6921
Mailing Address - Country:US
Mailing Address - Phone:616-990-3811
Mailing Address - Fax:
Practice Address - Street 1:328 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-6921
Practice Address - Country:US
Practice Address - Phone:616-990-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010010511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical