Provider Demographics
NPI:1205999174
Name:GRAHAM, MERRILL ELIZABETH (PHD, LMSW, RPT)
Entity type:Individual
Prefix:MRS
First Name:MERRILL
Middle Name:ELIZABETH
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:PHD, LMSW, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E BELTLINE AVE SE STE 340
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4362
Mailing Address - Country:US
Mailing Address - Phone:616-210-3888
Mailing Address - Fax:
Practice Address - Street 1:1550 E BELTLINE AVE SE STE 340
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4362
Practice Address - Country:US
Practice Address - Phone:616-210-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010684841041C0700X
MIMI68010684841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM94580Medicare ID - Type Unspecified
MI598550Medicare UPIN