Active NPI
Marissa Haller
- Counselor
- Livonia, MI
National Provider Identifier
1780314385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 6451022118
- Practice address
- 17940 Farmington Rd
Livonia, MI 48152-4444 - Phone
- (734) 526-1878
- NPI assigned
- Jun 15, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 6451022118 | MI | Primary |
Addresses
Primary practice location
17940 Farmington Rd
Livonia, MI 48152-4444
Mailing address
11415 Mayfield St
Livonia, MI 48150-5724
Phone (734) 363-3458
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 |
|---|---|---|---|
| 6451022118 | MI | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Richard Kneip, PH.D., P.C. | 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 and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Clarkston, MI
- NPI 1679739700
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656374400000",
"number": "1780314385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11415 MAYFIELD ST",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481505724",
"telephone_number": "734-363-3458"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17940 FARMINGTON RD",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481524444",
"telephone_number": "734-526-1878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALLER",
"first_name": "MARISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-06-15",
"last_updated": "2022-06-28",
"certification_date": "2022-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MI",
"license": "6451022118",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.