Provider Demographics
NPI:1609914027
Name:TUMONONG, MERRITA J (MSW ACSW LMSW LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MERRITA
Middle Name:J
Last Name:TUMONONG
Suffix:
Gender:F
Credentials:MSW ACSW LMSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3632
Mailing Address - Country:US
Mailing Address - Phone:616-240-4538
Mailing Address - Fax:616-957-1438
Practice Address - Street 1:4477 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3632
Practice Address - Country:US
Practice Address - Phone:616-240-4538
Practice Address - Fax:616-957-1438
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010345981041C0700X
MI4101005263106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008901440OtherBCBS