Individual provider Active NPI

David G Marshall, LPC

  • Professional Counselor
  • Grand Rapids, MI
National Provider Identifier
1023116324
Registry record updated Apr 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401012192 Issued in MI
Practice address
790 Fuller Ave NE
Grand Rapids, MI 49503-1918
Phone
(616) 336-3909
Fax
(616) 336-2475
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 6802076772 MI
Professional Counselor 101YP2500X 6401012192 MI Primary

Addresses

Primary practice location

790 Fuller Ave NE
Grand Rapids, MI 49503-1918

Mailing address

615 6TH Ave
Lake Odessa, MI 48849-1223
Phone (269) 838-5839

Other identifiers 1

IdentifierTypeStateIssuer
1715928MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6401012192MIMDProfessional Counselor
6802076772MIMDSocial Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429315200000",
    "number": "1023116324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 6TH AVE",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488491223",
            "telephone_number": "269-838-5839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031918",
            "telephone_number": "616-336-3909",
            "fax_number": "616-336-2475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "DAVID",
        "middle_name": "G",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2015-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6802076772",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401012192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1715928",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.