Provider Demographics
NPI:1598114936
Name:MARSH, JEFFREY DANIEL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DANIEL
Last Name:MARSH
Suffix:
Gender:M
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:PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Mailing Address - Street 2:300 68TH STREET, SE
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501
Mailing Address - Country:US
Mailing Address - Phone:616-559-5811
Mailing Address - Fax:616-559-5856
Practice Address - Street 1:300 68TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-6927
Practice Address - Country:US
Practice Address - Phone:616-559-5811
Practice Address - Fax:616-559-5856
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010732621041C0700X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No283Q00000XHospitalsPsychiatric Hospital