Provider Demographics
NPI:1710152855
Name:MERRELL, JOSEPH III (ACSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MERRELL
Suffix:III
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-0841
Mailing Address - Country:US
Mailing Address - Phone:616-844-7003
Mailing Address - Fax:
Practice Address - Street 1:41 WASHINGTON AVE
Practice Address - Street 2:SUITE 368
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1390
Practice Address - Country:US
Practice Address - Phone:616-844-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010161491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI089861-10OtherBCBS
MIMI1290Medicare PIN