Provider Demographics
NPI:1083019640
Name:HELMICK, MARION ANNE
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:ANNE
Last Name:HELMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 BLUE JAY ST
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-2858
Mailing Address - Country:US
Mailing Address - Phone:940-867-5772
Mailing Address - Fax:
Practice Address - Street 1:1102 BLUE JAY ST
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-2858
Practice Address - Country:US
Practice Address - Phone:940-867-5772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69729101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health