Organization · Type 2 NPI

Lake Superior Functional Psychotherapy, PLLC

Clinical Social Worker · Marquette, MI

NPI number 1174401848 Active

Practice location

104 Coles Dr Ste D
Marquette, MI 49855-4059

Call (906) 458-0914 Map

Fax (906) 205-0498

Mailing address

310 E Michigan St
Marquette, MI 49855-3826

Specialties and licenses

TaxonomyCodeLicense
Clinical Social Worker Primary 1041C0700XNone listed

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

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About NPI 1174401848

Lake Superior Functional Psychotherapy, PLLC's National Provider Identifier is 1174401848, issued on Aug 22, 2025. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Marquette, MI. The record was last updated on May 15, 2026.