Provider Demographics
NPI:1063661387
Name:NILES, MARION BETTINA (TLMHC)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:BETTINA
Last Name:NILES
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S BROADWAY ST
Mailing Address - Street 2:BURLINGTON
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-9407
Mailing Address - Country:US
Mailing Address - Phone:319-752-4000
Mailing Address - Fax:319-752-6933
Practice Address - Street 1:400 S BROADWAY ST
Practice Address - Street 2:BURLINGTON
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-9407
Practice Address - Country:US
Practice Address - Phone:319-752-4000
Practice Address - Fax:319-752-6933
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083763101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health