Active NPI
David G Marshall, LPC
- Professional Counselor
- Grand Rapids, MI
National Provider Identifier
1023116324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401012192
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1715928 | Medicaid | MI |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 6401012192 | MI | MD | Professional Counselor |
| 6802076772 | MI | MD | Social 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.