Provider Demographics
NPI:1730892431
Name:MARSH, KATHLEEN LOUISE (CRC LPC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:MARSH
Suffix:
Gender:F
Credentials:CRC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 E LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7415
Mailing Address - Country:US
Mailing Address - Phone:517-230-5695
Mailing Address - Fax:
Practice Address - Street 1:2970 E LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7415
Practice Address - Country:US
Practice Address - Phone:517-230-5695
Practice Address - Fax:855-978-1293
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health