Provider Demographics
NPI:1114016011
Name:MARION, MINDY JANE (QMHP)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:JANE
Last Name:MARION
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:MS
Other - First Name:MINDY
Other - Middle Name:JANE
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHP
Mailing Address - Street 1:402 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:VILLA GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61956-1113
Mailing Address - Country:US
Mailing Address - Phone:217-620-6233
Mailing Address - Fax:
Practice Address - Street 1:1801 FOX DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7236
Practice Address - Country:US
Practice Address - Phone:217-693-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health