Provider Demographics
NPI:1205403581
Name:BURTON, MARISSA LYNN (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:LYNN
Last Name:BURTON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:KOSTICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:1217 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3311
Mailing Address - Country:US
Mailing Address - Phone:989-667-9661
Mailing Address - Fax:
Practice Address - Street 1:1217 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3311
Practice Address - Country:US
Practice Address - Phone:989-667-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511182431041C0700X
MI6802091123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical