Basic Information
| Provider Information | |||||||||
| NPI: | 1467443903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURISEK | ||||||||
| FirstName: | MARION | ||||||||
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| Credential: | M. ED, L.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11111 HALL RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | UTICA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483175711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864193423 | ||||||||
| FaxNumber: | 5869974956 | ||||||||
| Practice Location | |||||||||
| Address1: | 11111 HALL RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | UTICA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483175711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864193423 | ||||||||
| FaxNumber: | 5869974956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 11/16/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401221246 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.