Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mark Douglas, LLMSW

Individual provider Clinical Social Worker · NPI 1477274587

Mark Douglas, LLMSW is a Clinical Social Worker in Grand Rapids, Michigan. Qualified in 2023, 3 years ago. Registered with an NPI since 2022.

Years since qualifying
3
In the registry since
2022

Practice location Address checks out

300 68th St SE
Grand Rapids, MI 49548-6927
Phone: (269) 903-7691
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X

Record details

NPI number1477274587
Entity typeIndividual (Type 1)
GenderMale
Credentials LLMSW
Sole proprietorNo
NPI enumeratedSeptember 7, 2022
Last updated in NPPESMay 17, 2023
Certification dateMay 17, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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