Individual provider Active NPI

Marylynn Gronow

  • Professional Counselor
  • Waterford, MI
National Provider Identifier
1740641497
Registry record updated Sep 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401014754 Issued in MI
Practice address
1435 N Oakland Blvd
Waterford, MI 48327-1549
Phone
(248) 406-0090
NPI assigned
Mar 9, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6401014754 MI Primary

Addresses

Primary practice location

1435 N Oakland Blvd
Waterford, MI 48327-1549

Mailing address

1435 N Oakland Blvd
Waterford, MI 48327-1549
Phone (248) 406-0090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231121003766 MI Practitioner - Mental Health Counselor 1759739246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Downriver Mental Health Clinic PCGroup PAC ID 7911995139, 289 clinicians

Practice addresses (Care Compare)

7300 Dixie Hwy
Suite 1000
Clarkston, MI 48346-5105
Phone (248) 922-2300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6401014754MIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Downriver Mental Health Clinic PC CurrentSince Jan 1, 2024 Accepting new patients
Downriver Mental Health Clinic PC Professional CurrentSince Jan 1, 2024 Accepting new patients

Locations

7300 Dixie Hwy
Ste 1000
Clarkston, MI 48346
Phone (248) 394-3739

1400 Abbot Rd
Ste 400
East Lansing, MI 48823
Phone (810) 220-2787

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.marylynngronow@150339.advancedmd-direct.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1457481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758931200000",
    "number": "1740641497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1435 N OAKLAND BLVD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271549",
            "telephone_number": "248-406-0090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1435 N OAKLAND BLVD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483271549",
            "telephone_number": "248-406-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRONOW",
        "first_name": "MARYLYNN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-09",
        "last_updated": "2025-09-27",
        "certification_date": "2025-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401014754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

Verify at the official NPI Registry.