Provider Demographics
NPI:1841488293
Name:MARSH, KERRY A (MA, PLPC)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:A
Last Name:MARSH
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 S CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5183
Mailing Address - Country:US
Mailing Address - Phone:417-890-2600
Mailing Address - Fax:417-890-2636
Practice Address - Street 1:3554 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5183
Practice Address - Country:US
Practice Address - Phone:417-890-2600
Practice Address - Fax:417-890-2636
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006009876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional