29 of Michigan’s 83 counties have no marriage and family therapist on record, home to 643,339 people

Imagine typing “family therapist near me” from a kitchen table in Gladwin or Ontonagon and watching the map zoom out, and out again, before the first pin appears. For many Michiganders that is not a figure of speech. Using federal provider records, we checked every county for marriage and family therapists with a local practice address.

29 Michigan counties, with 643,339 residents, have no marriage and family therapist on record

Of Michigan’s 83 counties, 29 have no individual NPI record for a marriage and family therapist (MFT) with a practice location in the county. Their combined population is 643,339, roughly 6.4% of the state. Statewide there are 730 such records, so this is not a story about Michigan having no MFTs. It is a story about where they are not.

The largest zero county by far is Bay County, with 103,008 residents and the city of Bay City. The rest are smaller: Hillsdale (45,654), Mecosta (41,242), Clare (31,218), Mason (29,207) and Alpena (28,880) lead the list, and Keweenaw (2,133) is the smallest.

Where the zero counties are, and how they overlap with shortage areas

Twenty-one of the 29 are in the Lower Peninsula, most of them in a band across the northern and central counties: Alcona, Alpena, Antrim, Arenac, Benzie, Clare, Crawford, Gladwin, Kalkaska, Lake, Mason, Mecosta, Missaukee, Montmorency, Oceana, Ogemaw, Otsego, Presque Isle and Roscommon, plus Bay and Hillsdale farther south. The other eight are in the Upper Peninsula: Alger, Dickinson, Keweenaw, Luce, Mackinac, Menominee, Ontonagon and Schoolcraft. Our Upper Peninsula therapy access report looks at that region in detail.

Federal shortage data points the same way. In the Health Resources and Services Administration (HRSA) mental health file, 28 of the 29 counties have at least one current Health Professional Shortage Area (HPSA) designation. Alpena County is the only zero county without one. A shortage designation measures all core mental health professionals, not only MFTs, so the two datasets are independent views of a similar problem. We explain how HRSA designations and scores work in our report on Michigan’s mental health shortage areas.

Zero local MFTs does not mean zero help. Residents of these counties may be served by licensed professional counselors, social workers, psychologists and community mental health agencies, which this count does not include.

Largest and smallest Michigan counties with no MFT practice location

Methodology: how a county ends up with zero

We pulled every individual (Type 1) record in the CMS NPPES registry with taxonomy 106H00000X, Marriage & Family Therapist, and a Michigan practice location on October 8, 2026. Each practice ZIP code was assigned to the county containing its centroid (Census 2023 ZCTA Gazetteer and cartographic county boundaries). A county shows zero when no record’s practice ZIP falls inside it. Populations are 2020-2024 American Community Survey 5-year estimates, and the 6.4% figure is 643,339 divided by Michigan’s 10,077,761. Shortage counts come from HRSA’s mental health HPSA detail file, retrieved the same day, counting designations with “Designated” status.

The Bay County zero, stated precisely: no individual NPI record with the MFT taxonomy lists a practice ZIP in Bay County. The registry does contain two NPIs in Bay City with that taxonomy, but both are organization (Type 2) records, one for a regional hospital and one for a counseling agency. Clinicians at those organizations may well include marriage and family therapists who bill under the organization’s number or who list a different primary specialty.

Limitations of a zero count

• An NPI record is not proof of an active license, and a missing record is not proof of absence. Some therapists never obtain an individual NPI.
• ZIP centroids can place a practice near a county line in the neighboring county.
• Only the MFT taxonomy is counted. Counselors and social workers who do couples and family work are excluded.
• Practice addresses change. A single opening or closing can move a small county on or off this list.

What this means for couples and families in these counties

Living in a zero county does not say anything about the health of your relationships, and it does not mean people there need therapy more than anyone else. It means that if you want a marriage and family therapist, the closest office may be in another county, and a long drive can make weekly sessions hard to sustain.

Online sessions can widen your options, within clear limits. Michigan’s Public Health Code makes it a felony to practice a regulated health profession without a license (MCL 333.16294), and its list of exemptions has no general carve-out for out-of-state clinicians working by telehealth. Licensure generally follows where the client is located. In practice that means two things: a therapist licensed in Michigan can meet with you by video from anywhere in the state, and you need to be physically in Michigan during each session. A therapist licensed only in another state generally cannot treat you here by video.

Video care is not a fix for everything. It needs a private space and a steady connection, and some people do better in the room. Iryna Morhunova-Sutton, LLMFT, works with individuals, couples and families online only, for clients anywhere in Michigan, from Cadillac to Escanaba. Read how online therapy in Michigan works, or use our guide on how to find a couples therapist to compare options. The full county ranking is in our report on therapist density across Michigan.

When this list is updated

We re-run the NPPES pull quarterly and refresh shortage designations at the same time. Populations update with each new ACS 5-year release.