Active NPI
Marissa Ellen Siegel, QMHS
- Counselor
- Ionia, MI
National Provider Identifier
1689138430
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 375 Apple Tree Dr.
Ionia, MI 48846-7506 - Phone
- (616) 527-1790
- Fax
- (616) 527-0538
- NPI assigned
- Jan 25, 2019
- Last updated
- Feb 16, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | MI | Primary | |
| Counselor | 101Y00000X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X |
Addresses
Primary practice location
375 Apple Tree Dr.
Ionia, MI 48846-7506
Mailing address
375 Apple Tree Dr.
Ionia, MI 48846-7506
Phone (616) 527-1790
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1715928 | Medicaid | MI |
Other names 1
- Ms. Marissa Ellen Sander
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Haven for Kids, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Behaven Kids - Butler
- Community/Behavioral Health Agency
- West Chester, OH
- NPI 1366719866
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676505600000",
"number": "1689138430",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "375 APPLE TREE DR.",
"city": "IONIA",
"state": "MI",
"postal_code": "488467506",
"telephone_number": "616-527-1790",
"fax_number": "616-527-0538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 APPLE TREE DR.",
"city": "IONIA",
"state": "MI",
"postal_code": "488467506",
"telephone_number": "616-527-1790",
"fax_number": "616-527-0538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIEGEL",
"first_name": "MARISSA",
"middle_name": "ELLEN",
"name_prefix": "Mrs.",
"credential": "QMHS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-25",
"last_updated": "2023-02-16",
"certification_date": "2023-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MI",
"license": null,
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1715928",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARISSA",
"last_name": "SANDER",
"middle_name": "ELLEN",
"prefix": "MS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Ionia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.