Provider Demographics
NPI:1811005697
Name:TERBORGH, MERRI ANN (MA LMSW CCM)
Entity Type:Individual
Prefix:MS
First Name:MERRI
Middle Name:ANN
Last Name:TERBORGH
Suffix:
Gender:F
Credentials:MA LMSW CCM
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 537
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:MI
Mailing Address - Zip Code:49067
Mailing Address - Country:US
Mailing Address - Phone:269-646-9321
Mailing Address - Fax:
Practice Address - Street 1:56465 OLD 119
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:MI
Practice Address - Zip Code:49067
Practice Address - Country:US
Practice Address - Phone:269-646-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010351821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
08923708802Medicare ID - Type Unspecified